Transcatheter tricuspid repair reduced death and heart failure admission at three years

Design

Randomised trial, 2:1, transcatheter tricuspid repair plus medical therapy vs medical therapy alone

Population

360 patients, mean age 80.3 years, with symptomatic severe tricuspid regurgitation and increased risk of heart failure events

Primary outcome

Hierarchical composite of death, heart failure hospitalisation and quality of life at 1 year; death or heart failure hospitalisation at 3 years

Effect

Win ratio 2.42 (95% CI 1.76 to 3.33); 3-year event-free 52.4% vs 21.0%, HR 0.40 (0.29 to 0.55)

TRIC-I-HF randomised 360 patients with symptomatic severe tricuspid regurgitation and a raised risk of future heart failure events, in a 2:1 ratio, to transcatheter tricuspid-valve repair plus medical therapy or medical therapy alone. Mean age was 80.3 years and 56.4% were women.

The first primary end point was a hierarchical composite of death, heart failure hospitalisation and quality-of-life improvement at one year, analysed by win ratio. It was 2.42 (95% CI 1.76 to 3.33) in favour of repair. The second primary end point, freedom from death or heart failure hospitalisation through three years, was 52.4% with repair against 21.0% with medical therapy alone (hazard ratio 0.40, 95% CI 0.29 to 0.55). Major adverse events within 30 days occurred in 14 patients (5.9%) in the repair group.

A win ratio combines outcomes of different importance, and the quality-of-life element is patient-reported, so it is worth checking how much of the result is driven by each component in the full paper. The population was older and selected for risk of heart failure events, so the finding applies to patients like these and not to every person with tricuspid regurgitation.

• Ask whether an older patient with severe tricuspid regurgitation and recurrent congestion has been assessed by a structural heart team.
• Three-year freedom from death or heart failure hospitalisation was 52.4% with repair and 21.0% with medical therapy alone.
• About 6% had a major adverse event within 30 days, which belongs in the consent discussion.
• Optimise diuretics and other medical therapy in both groups; repair was added to it, not a replacement.

Why it matters

It gives randomised data on death and heart failure admission for a transcatheter tricuspid procedure.

Don't overread it

The first primary end point includes a patient-reported element, and the trial applies to a selected, older, higher-risk group.

The statistics, in plain English

A win ratio of 2.42 means that, across all pairings of patients, those treated with repair came out ahead about 2.4 times as often as they came out behind. It does not translate directly into a risk reduction, which is why the hazard ratio at three years is reported separately.

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