Transcatheter tricuspid repair reduces death or heart failure admission over three years

Design

Randomised, open-label, 2:1 allocation

Population

360 patients (mean age 80) with symptomatic severe tricuspid regurgitation

Primary outcome

Hierarchical composite at 1 year (win ratio); death or HF hospitalisation through 3 years

Effect

Win ratio 2.42 (95% CI 1.76–3.33); 3-year HR 0.40 (0.29–0.55)

TRIC-I-HF randomised 360 patients with symptomatic severe tricuspid regurgitation and a raised risk of heart failure events 2:1 to transcatheter tricuspid repair plus medical therapy or medical therapy alone. They were old (mean 80 years) and 56% were women — the population most clinics actually see.

Repair won the hierarchical primary end point of death, heart failure hospitalisation and quality-of-life improvement at one year (win ratio 2.42, 95% CI 1.76–3.33). Because that was positive, the second primary end point was tested: freedom from death or heart failure hospitalisation through three years was 52.4% with repair against 21.0% with medical therapy (HR 0.40, 0.29–0.55). Major adverse events at 30 days occurred in 5.9% of repaired patients.

Earlier tricuspid trials were driven mainly by quality of life. This one shows an effect on hard outcomes, which changes how severe tricuspid regurgitation should be referred. It was open-label, and the win ratio still leans on quality of life, but the three-year hard composite is the number to quote.

• Refer symptomatic patients with severe tricuspid regurgitation for heart team assessment rather than managing with diuretics alone.
• Quantify tricuspid regurgitation on every echo in heart failure patients — severity drives eligibility.
• Age around 80 is not a reason to withhold referral; that was the average trial patient.
• Counsel patients on a roughly 6% risk of a major adverse event within 30 days.
• Continue optimised heart failure medical therapy after repair; the trial added repair to it, not instead of it.

Why it matters

Tricuspid regurgitation moves from a symptom target to a condition where intervening changes survival and admissions.

Don't overread it

The trial was open-label and the one-year win ratio includes quality of life, which is open to expectation effects.

The statistics, in plain English

A win ratio of 2.42 means that when each repaired patient was compared with each medically treated patient, working down death, then admission, then quality of life, the repaired patient came out better about 2.4 times as often as worse. A hazard ratio of 0.40 means the rate of death or heart failure admission was about 60% lower with repair. The confidence interval (0.29–0.55) is well clear of 1.0.

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