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

Design

Randomised 2:1, open-label, multicentre

Population

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

Primary outcome

Hierarchical composite at 1 year; then death or heart failure admission through 3 years

Effect

Win ratio 2.42 (95% CI 1.76–3.33); HR 0.40 (0.29–0.55) for death or HF admission

TRIC-I-HF randomised 360 patients with symptomatic severe tricuspid regurgitation and a raised risk of heart failure events, two to one, to transcatheter tricuspid repair plus medical therapy or medical therapy alone. They were old, mean age 80, and more than half were women. The trial was published in NEJM on 30 August 2026.

Repair won on the first primary endpoint, a hierarchical composite of death, heart failure admission and quality-of-life gain at one year (win ratio 2.42). The second, harder endpoint was death or heart failure admission through three years: 52% of the repair group were free of it, against 21% on medical therapy alone (HR 0.40). Major adverse events within 30 days occurred in about 6% after repair.

Earlier tricuspid trials won mainly on symptoms and quality of life. This one reports a difference in death and admissions, which changes how a heart failure team should view the patient with torrential tricuspid regurgitation and repeated diuretic escalation. The trial was not blinded, and access to transcatheter tricuspid devices in India remains limited to a few centres.

• Grade tricuspid regurgitation on every echo in heart failure patients, not only the left-sided valves.
• Refer symptomatic severe tricuspid regurgitation with repeated admissions to a heart team for transcatheter assessment.
• Optimise diuretics and rhythm control first; the trial added repair on top of medical therapy.
• Discuss procedural risk honestly: about one in seventeen had a major adverse event within 30 days.

Why it matters

Tricuspid regurgitation has been treated as a marker of advanced disease; this trial suggests fixing it changes outcomes.

Don't overread it

The trial was open-label and the population was very old; benefit in younger patients is untested.

The statistics, in plain English

A win ratio of 2.42 means that, comparing patients pair by pair on death first, then admissions, then quality of life, the repair patient came out ahead about 2.4 times as often as behind. The hazard ratio of 0.40 for death or admission is a harder number and less prone to bias from an unblinded design.

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