VExUS Score and Hepatorenal Congestion Improvements After Transcatheter Tricuspid Intervention: Clinical and Prognostic Insights.

BACKGROUND

Severe tricuspid regurgitation (TR) is associated with morbidity and mortality and linked to intravascular venous congestion. Venous ultrasound of the hepatic, portal, and intrarenal veins-often integrated via the Venous Excess Ultrasound (VExUS) score-offers prognostic insight in heart failure, but its utility in transcatheter tricuspid valve intervention (TTVI) remains undefined.

OBJECTIVES

The aim of this study was to evaluate changes in hepatic, portal, and intrarenal venous flow before vs after TTVI, assess their durability, and explore associations with prognosis and functional status.

METHODS

In this prospective multicenter cohort patients undergoing TTVI (2022-2024) were included. Venous ultrasound was performed 24 hours pre- and postprocedure. Functional status, frailty, biomarkers, venous ultrasound and echocardiography were assessed at baseline and at 1, 6, and 12 months. All-cause mortality and heart failure hospitalization were recorded. Survival was analyzed by Kaplan-Meier and Cox regression.

RESULTS

A total of 64 patients were included; mean age was 76.7 ± 8.1 years; 76.6% were women. Procedures included edge-to-edge repair (60.9%), percutaneous annuloplasty (18.7%), orthotopic replacement (14.1%), and heterotopic replacement (6.3%). At baseline, 70% had VExUS grade 3. Within 24 hours hepatic vein, portal pulsatility, and intrarenal venous flows improved, reclassifying 66% to VExUS ≤1, despite no change in diuretic dose or weight. Venous ultrasound improvements persisted during follow-up. Postprocedure VExUS grade 3 at 24 hours was a strong predictor of mortality (HR: 5.55; 95% CI: 1.60-19.21; P = 0.007).

CONCLUSIONS

TTVI improved hepatic, portal, and intrarenal venous flow within 24 hours, with sustained effects at 1 year. Postprocedure VExUS score was associated with mortality and may serve as a procedural success indicator.