Tricuspid-Valve Intervention in Heart Failure.
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Hausleiter Jörg, Stocker Thomas J, Geisler Tobias, Lurz Philipp, Rottbauer Wolfgang, Lubos Edith, Schofer Niklas, Frerker Christian, Frank Johanne, Thiele Holger, Osteresch Rico, Rudolph Volker, Lauten Alexander, Xhepa Erion, Rothe Jürgen, Rassaf Tienush, Baldus Stephan, Nickenig Georg, Leistner David M, Tigges Eike, Kehl Victoria, Kessler Mirjam, Kister Tobias, Ruf Tobias, Gerçek Muhammed, Gawaz Meinrad, Frank Derk, Eitel Ingo, von Bardeleben Ralph Stephan, Kalbacher Daniel, Soliman Osama, Näbauer Michael, Massberg Steffen, TRIC-I-HF-DZHK24 Investigators
Аннотация
METHODS: We randomly assigned patients with symptomatic severe tricuspid regurgitation and an increased risk of future heart-failure events in a 2:1 ratio to tricuspid-valve repair plus medical therapy (tricuspid-repair group) or medical therapy alone (medical-therapy group). The first primary end point was a hierarchical composite of death from any cause, hospitalization for heart failure, and quality-of-life improvement at 1 year, assessed by win ratio. If the between-group difference was significant, a second primary end point would be tested: a composite of death from any cause or hospitalization for heart failure through 3 years.
RESULTS: A total of 360 patients underwent randomization (237 patients were assigned to the tricuspid-repair group and 123 to the medical-therapy group). The mean (±SD) age of the patients was 80.3±6.4 years, and 56.4% were women. The win ratio for the first primary end point was 2.42 (95% confidence interval [CI], 1.76 to 3.33; P<0.001), favoring tricuspid-valve repair. The Kaplan-Meier estimate for freedom from death from any cause or hospitalization for heart failure (second primary end point) through 3 years was 52.4% (95% CI, 43.2 to 63.6) in the tricuspid-repair group and 21.0% (95% CI, 12.7 to 34.6) in the medical-therapy group (hazard ratio for death from any cause or hospitalization for heart failure, 0.40; 95% CI, 0.29 to 0.55; P<0.001). Major adverse events within 30 days occurred in 14 patients (5.9%) in the tricuspid-repair group.
CONCLUSIONS: Among patients with symptomatic severe tricuspid regurgitation, transcatheter tricuspid-valve repair plus medical therapy was superior to medical therapy alone with respect to a hierarchical composite of death from any cause, hospitalization for heart failure, and quality-of-life improvement at 1 year and was also associated with a lower risk of a composite of death from any cause or hospitalization for heart failure through 3 years. (Funded by the German Center for Cardiovascular Research and others; TRIC-I-HF ClinicalTrials.gov number, NCT04634266.).