Applying the 2025 ESC/EACTS Recommendations for the Treatment of Severe Tricuspid Regurgitation to Real-World Practice.
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Stolz Lukas, Kresoja Karl-Patrik, von Stein Jennifer, Fortmeier Vera, Pauschinger Christoph, Rottbauer Wolfgang, Kassar Mohammad, Goebel Bjoern, Denti Paolo, Achouh Paul, Rassaf Tienush, Barreiro-Perez Manuel, Boekstegers Peter, Rück Andreas, Zdanyte Monika, Adamo Marianna, Vincent Flavien, Schlegel Philipp, Rosch Sebastian, Wild Mirjam G, Besler Christian, Toggweiler Stefan, Brunner Stephanie, Grapsa Julia, Patterson Tiffany, Thiele Holger, Kister Tobias, Tarantini Giuseppe, Masiero Giulia, Kempton Hannah, De Carlo Marco, Giannini Cristina, Voss Fabian, Polzin Amin, Rubbio Antonio Popolo, Bedogni Francesco, Stolte Thorald, Nestelberger Thomas, Benito-González Tomás, Sánchez-Muñóz Enrique, Vrijkorte Martijn, Swaans Martin, Konstandin Mathias H, Van Belle Eric, Metra Marco, Geisler Tobias, Estévez-Loureiro Rodrigo, Mahabadi Amir Abbas, Karam Nicole, Maisano Francesco, Lauten Philipp, Kessler Mirjam, Kalbacher Daniel, Rudolph Volker, Iliadis Christos, Lurz Philipp, Praz Fabien, Hausleiter Jörg, EuroTR Investigators
Аннотация
OBJECTIVES: The aim of this study was to evaluate clinical and symptomatic outcomes in such "OMT candidate" patients.
METHODS: Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting ≥1 exclusion criterion ("OMT candidates") were compared with those meeting current recommendations ("TTVI appropriate") regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH).
RESULTS: Among 1,626 T-TEER patients, 213 (13.1%) met ≥1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of ≥1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, "OMT candidates" had lower HFH-free survival than "TTVI-appropriate" patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (≥1 NYHA functional class in 56.2% vs 59.5%; P = 0.68).
CONCLUSIONS: T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.