TriValve Registry Compares Transcatheter Tricuspid Valve Interventions Versus Medical Therapy

September 27, 2019—Findings from an investigation of the potential benefit of transcatheter tricuspid valve interventions (TTVI) over medical therapy in a propensity score matched population were published by Maurizio Taramasso, MD, et al online in Journal of the American College of Cardiology (JACC). Publication was simultaneous with Dr. Taramasso's presentation of the study in a late-breaking trial session at TCT 2019, the 31st annual Transcatheter Cardiovascular Therapeutics scientific symposium held September 25–29 in San Francisco, California.

As summarized in JACC, the TriValve (Transcatheter Tricuspid Valve Therapies) registry identified 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018.

A control cohort formed by two large retrospective registries enrolling medically managed patients with moderate or greater tricuspid regurgitation (TR) in Europe and North America (n = 1,179 patients) were propensity score 1:1 matched (distance ± 0.2 SD) using age, Euroscore II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. The primary endpoint was 1-year mortality or heart failure rehospitalization or the composite.

After matching, investigators identified 268 adequately matched pairs of patients. Compared to controls, TTVI patients had lower 1-year mortality (23 ± 3% vs 36 ± 3%; P = .001), rehospitalization (26 ± 3% vs 47 ± 3%; P < .0001), and composite endpoint (32 ± 4% vs 49 ± 3%; P = .0003).

The investigators found that TTVI was associated with greater survival and freedom from heart failure rehospitalization (hazard ratio [HR], 0.6 [0.46–0.79]; P = .003, unadjusted), which remained significant after adjusting for sex, NYHA class, right ventricular dysfunction, and atrial fibrillation (HR, 0.39 [0.26–0.59]; P < .0001), and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR, 0.35 [0.23–.54]; P < .0001).

This propensity matched case-control study showed that TTVI is associated with greater survival and reduced heart failure rehospitalization compared with medical therapy alone, concluded the investigators in JACC and they advised that randomized trials should be performed to confirm these results.