The Canadian journal of cardiology · 2026
Transcatheter Tricuspid Valve Replacement Reduces Heart Failure Hospitalization: Insights From the Canadian Evoque Registry.
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Patrascu Alexandru, Millar Kevin, Labbé Benoit, Attumalil Thomas, Portillo Juan Hernando, Traynor Bryan, Sathananthan Gnalini, Alkasab Mohammed, Kim Kitae, Cheung Anson, Dagenais François, Bisleri Gianluigi, Moss Robert, Ong Geraldine, Derry Kendra, Alnasser Sami, Webb John G, Rodés-Cabau Josep, Boone Robert H, Fam Neil P
Аннотация
BACKGROUND: Severe tricuspid regurgitation (TR) causes high morbidity and recurrent heart failure hospitalization (HFH). Transcatheter tricuspid valve replacement (TTVR) consistently eliminates TR, but real-world data on HFH reduction are limited. We therefore evaluated the effect of TTVR on HFH and clinical outcomes in a diverse cohort of compassionate-use and trial patients.
METHODS: This prospective, multicentre Canadian registry included 75 high-risk patients (Society of Thoracic Surgeons [STS] score 8.2% ± 5.9%) who underwent TTVR with the EVOQUE system (Edwards Lifesciences, Irvine, CA). The primary end point was a composite of all-cause death or HFH within 1 year after TTVR. Secondary end points included the annualized HFH rate 12 months before vs after TTVR, symptoms, quality of life (using the Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity.
RESULTS: Procedural success was high (technical: 97.3%; device: 93.3%), with sustained TR reduction to ≤ mild (94.3%), and a 6.7% 1-year mortality. TTVR resulted in a 76.1% relative reduction in HFH (P < 0.001). New York Heart Association class III-IV decreased from 76% to 10% (P < 0.001). Significant improvements were observed in 6-minute walk distance (260.8 ± 104.7 to 334.5 ± 103.5 m; P < 0.001) and KCCQ score (56.2 ± 15.2 to 73.5 ± 19.2 points; P = 0.001). Multivariable analysis identified baseline New York Heart Association class IV (odds ratio, 3.96; P = 0.003) and previous HFH (odds ratio, 2.31; P = 0.033) as independent predictors of the composite end point (HFH and/or death). Comparative analysis showed that although compassionate-use patients (n = 24) had a higher-risk profile than trial patients (n = 51), both cohorts achieved comparable and significant clinical improvements.
CONCLUSIONS: In a diverse, high-risk cohort, TTVR dramatically reduced HFH and significantly improved quality of life. These results reinforce the therapeutic benefits of TTVR in high-risk patients with severe TR.
METHODS: This prospective, multicentre Canadian registry included 75 high-risk patients (Society of Thoracic Surgeons [STS] score 8.2% ± 5.9%) who underwent TTVR with the EVOQUE system (Edwards Lifesciences, Irvine, CA). The primary end point was a composite of all-cause death or HFH within 1 year after TTVR. Secondary end points included the annualized HFH rate 12 months before vs after TTVR, symptoms, quality of life (using the Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity.
RESULTS: Procedural success was high (technical: 97.3%; device: 93.3%), with sustained TR reduction to ≤ mild (94.3%), and a 6.7% 1-year mortality. TTVR resulted in a 76.1% relative reduction in HFH (P < 0.001). New York Heart Association class III-IV decreased from 76% to 10% (P < 0.001). Significant improvements were observed in 6-minute walk distance (260.8 ± 104.7 to 334.5 ± 103.5 m; P < 0.001) and KCCQ score (56.2 ± 15.2 to 73.5 ± 19.2 points; P = 0.001). Multivariable analysis identified baseline New York Heart Association class IV (odds ratio, 3.96; P = 0.003) and previous HFH (odds ratio, 2.31; P = 0.033) as independent predictors of the composite end point (HFH and/or death). Comparative analysis showed that although compassionate-use patients (n = 24) had a higher-risk profile than trial patients (n = 51), both cohorts achieved comparable and significant clinical improvements.
CONCLUSIONS: In a diverse, high-risk cohort, TTVR dramatically reduced HFH and significantly improved quality of life. These results reinforce the therapeutic benefits of TTVR in high-risk patients with severe TR.