Comparison of Early Outcomes Following Transjugular Transcatheter Tricuspid Valve Replacement Between Large vs Small Annulus.

BACKGROUND

Transcatheter tricuspid valve replacement (TTVR) is a promising therapy for tricuspid regurgitation (TR), but comprehensive comparison of clinical outcomes stratified by annular size remains understudied.

OBJECTIVES

The aim of this study was to evaluate and compare early outcomes in patients treated with transjugular TTVR stratified by annular size.

METHODS

Patients with grade ≥3 TR undergoing LuX-Valve Plus TTVR were enrolled across 13 centers from May 2022 to March 2024. They were stratified into a large-annulus group (LAG) (perimeter-derived annular diameter ≥51 mm or maximal annular diameter ≥55 mm) and a small-annulus group (SAG). Early outcomes included device, procedural, or intraprocedural success; TR reduction; and 30-day primary endpoints or clinical success.

RESULTS

Among 159 patients, baseline TR severity was greater in the LAG (n = 42) than the SAG (n = 117). Superior trial-defined device or procedural success (81.0% vs 97.4%; P = 0.001) and Tricuspid Valve Academic Research-defined intraprocedural success (78.6% vs 96.6%; P = 0.001) were observed in the SAG. At 30 days, primary endpoint rates were similar (trial defined, 16.7% vs 14.5% [P = 0.936]; TRISCEND II [Edwards EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device] defined, 21.4% vs 22.2% [P = 1.000]), but Tricuspid Valve Academic Research Consortium clinical success favored the SAG (73.8% vs 94.9%; P = 0.001). Severe paravalvular regurgitation (7.1% vs 0.0%; P = 0.017) occurred only in the LAG, while new-onset third-degree atrioventricular block or pacemaker implantation (0.0% vs 9.4%) was exclusive to the SAG. Severe bleeding was comparable between the groups (14.3% vs 9.4%; P = 0.391).

CONCLUSIONS

LuX-Valve Plus TTVR appears to be safe and effective in TR patients regardless of annular size, but TR reduction was more significant in the SAG, with specific differences in some major adverse events between groups.