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Comparative Study
. 2025 Jan;18(1):e014825.
doi: 10.1161/CIRCINTERVENTIONS.124.014825. Epub 2024 Nov 18.

Comparison of Transcatheter Versus Surgical Tricuspid Repair Among Patients With Tricuspid Regurgitation: Two-Year Results

Tomonari M Shimoda #  1 , Hiroki A Ueyama #  2 , Yoshihisa Miyamoto  3 , Atsuyuki Watanabe  4 , Hiroshi Gotanda  5 , Dhaval Kolte  6 , Azeem Latib  7 , Tsuyoshi Kaneko  8 , Alan Zajarias  9 , Sammy Elmariah  10 , Hiroo Takayama  11 , Yusuke Tsugawa #  12   13 , Toshiki Kuno #  6
Affiliations
Comparative Study

Comparison of Transcatheter Versus Surgical Tricuspid Repair Among Patients With Tricuspid Regurgitation: Two-Year Results

Tomonari M Shimoda et al. Circ Cardiovasc Interv. 2025 Jan.

Abstract

Background: Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. We aimed to compare outcomes between these 2 approaches.

Methods: We analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention. A propensity score matching weight analysis was used to adjust for potential confounders.

Results: A total of 1143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. After adjustment for potential confounders, we found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair (adjusted hazard ratio, 0.84 [95% CI, 0.63-1.13]). Patients treated with T-TEER experienced lower in-hospital mortality (2.5% versus 12.5%, P<0.001) and permanent pacemaker implantation rates (0.0% versus 12.7%, P<0.001) than those treated by surgical repair. At 2 years, we found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group (subdistribution hazard ratio, 8.03 [95% CI, 2.87-22.48]).

Conclusions: Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy.

Keywords: Medicare; catheters; heart failure; mortality; tricuspid valve.

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Conflict of interest statement

Dr Latib has been a consultant and serves on the Advisory Board of Medtronic, Abbott, Boston Scientific, Edwards Lifesciences, V-Dyne, NeoChord, Nyra Medical, Tioga, Shifamed, and Philips. Dr Kaneko has received consulting fees from Edwards Lifesciences, Medtronic, 4C Medical, CardioMech, and Cook Medical; and has been a speaker for Abbott and Baylis. Dr Zajarias has received consulting fees from Edwards Lifesciences. Dr Elmariah has received consulting fees from Edwards Lifesciences and Medtronic. Dr Takayama has received consulting fees from Artivion and Edwards Lifesciences. Dr Tsugawa serves on the board of directors of M3, Inc. Study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the manuscript for publication. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Two-year all-cause mortality after propensity score matching weight analysis. Kaplan-Meier analysis of all-cause mortality. Solid lines represent the estimates, and the surrounding bands represent the 95% CIs. aHR indicates adjusted hazard ratio; and T-TEER, tricuspid transcatheter edge-to-edge repair.
Figure 2.
Figure 2.
Two-year outcomes regarding heart failure hospitalization and stroke after propensity score matching weight analysis. Analysis of (A) heart failure hospitalization and (B) stroke. Solid lines represent the estimates, and the surrounding bands represent the 95% CIs. sdHR indicates subdistribution hazard ratio; and T-TEER, tricuspid transcatheter edge-to-edge repair.
Figure 3.
Figure 3.
Two-year outcomes regarding pacemaker implantations and tricuspid valve reinterventions after propensity score matching weight analysis. Analysis of (A) permanent pacemaker implantations, (B) tricuspid valve reinterventions, and (C) tricuspid valve reinterventions specific to tricuspid transcatheter edge-to-edge repair (T-TEER). Solid lines represent the estimates, and the surrounding bands represent the 95% CIs. sdHR indicates subdistribution hazard ratio.
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Comment in

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