Transcatheter tricuspid repair beat medical therapy alone in severe regurgitation

Design

Randomised, open-label trial, 2:1 allocation

Population

360 patients with symptomatic severe tricuspid regurgitation, mean age 80

Primary outcome

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

Effect

Win ratio 2.42 (1.76–3.33); event-free at 3 years 52.4% vs 21.0%, 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 just over half were women. It was published on 30 August.

The first primary end point, a hierarchy of death, heart failure admission and quality-of-life gain at one year, favoured repair with a win ratio of 2.42 (95% CI 1.76–3.33). At three years, 52.4% of the repair group were alive and free of heart failure admission against 21.0% on medical therapy (HR 0.40, 95% CI 0.29–0.55). Major adverse events within 30 days occurred in 5.9% after repair.

Tricuspid regurgitation has long been the valve lesion that clinicians note and leave alone, managing it with diuretics. This trial, with hard outcomes over three years, makes a referral conversation reasonable for symptomatic patients. The trial was open-label by necessity, and quality of life is part of the first end point, which an unblinded procedure can inflate. The three-year composite of death or admission is less open to that bias.

• Consider referring patients with symptomatic severe tricuspid regurgitation to a heart team rather than relying on diuretics alone.
• Look for severe tricuspid regurgitation on the echo report of older patients with recurrent right-sided congestion.
• Expect about 1 in 17 patients to have a major adverse event within 30 days of repair.
• Check local availability, since transcatheter tricuspid repair is limited to a few specialist centres in India.

Why it matters

It challenges the long-standing habit of watching tricuspid regurgitation rather than treating it.

Don't overread it

The quality-of-life part of the first end point is open to bias in an unblinded procedural trial.

The statistics, in plain English

A win ratio of 2.42 means that, comparing patients pair by pair on death first, then admission, then quality of life, repair came out ahead about 2.4 times as often as medical therapy. The hazard ratio of 0.40 for death or admission means a 60% lower rate over three years.

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