Transcatheter tricuspid valve interventions (TTVI), compared with medical therapy alone, appears to improve survival and reduce rehospitalization due to heart failure (HF), as shown in this propensity-matched, case-control study.
A total of 472 patients from 22 European and North American centres who underwent TTVI from 2016 to 2018 were included in the TriValve (Transcatheter Tricuspid Valve Therapies) registry. A control cohort from two large retrospective registries that enrolled patients with moderate to severe tricuspid regurgitation in Europe and North America (n=1,179) was propensity-score matched 1:1 on the basis of age, EuroSCORE II and systolic pulmonary artery pressure.
Cox regression analysis was used to examine survival. One-year mortality or HF rehospitalization or the composite was the primary endpoint.
Propensity-score matching identified 268 pairs. TTVI patients had lower 1-year mortality (23±3 percent vs 36±3 percent; p=0.001), rehospitalization (26±3 percent vs 47±3 percent; p<0.0001) and composite endpoint (32±4 percent vs 49±3 percent; p=0.0003) than controls.
TTVI correlated with better survival and freedom from HF rehospitalization (hazard ratio [HR], 0.60, 95 percent confidence interval [CI], 0.46–0.79; p-unadjusted=0.003), and this association persisted even after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction and atrial fibrillation (HR, 0.39, 95 percent CI, 0.26–0.59; p<0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR, 0.35, 95 percent CI, 0.23–0.54; p<0.0001).
“Randomized trials should be performed to confirm these results,” the investigators said.