Right heart failure and mortality in patients undergoing transcatheter tricuspid valve interventions
- PMID: 40068787
- DOI: 10.1016/j.ijcard.2025.133137
Right heart failure and mortality in patients undergoing transcatheter tricuspid valve interventions
Abstract
Aims: To assess the association between right heart failure (RHF) and mortality in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI), and to determine whether clinical RHF status reduces the survival benefit of successful versus failed TTVI.
Methods and results: The TriValve International Registry (Transcatheter Tricuspid Valve Therapies) is a multicenter registry collecting data of patients with symptomatic, severe or greater TR undergoing TTVI. The population was stratified according to RHF status defined by the following clinical criteria: history of previous hospitalization for RHF (<1 year) OR presence of signs of RHF (jugular venous distension, ascites, peripheral oedema) OR high dose diuretic (≥125 mg/day of furosemide or equivalent). The outcome of interest was 1-year all-cause death. Among 639 patients included in the TriValve registry, 498 had complete data regarding RHF status. Overall, 54 (10.8 %) patients had no criteria for RHF, 133 (26.7 %) patients fulfilled 1 criterion, 240 (48.2 %) 2 criteria and 71 (14.3 %) 3 criteria. At a median follow-up of 216 days (IQR 49-372 days), cumulative incidence of all-cause death was higher in patients with 2 or 3 RHF criteria versus those with no or 1 RHF criterion (adjusted HR 2.91-95 % CI 1.46-5.83, P = 0.002). However, RHF status did not influence the association between procedural success and all-cause death at 1-year follow-up (p for interaction 0.857).
Conclusions: In a large real-world population undergoing TTVI for severe TR, the presence of at least 2 RHF clinical criteria was independently associated with an increased risk of 1-year mortality. Procedural success was associated with a lower risk of mortality regardless of RHF status.
Keywords: Mortality; Outcome; Right heart failure; Transcatheter tricuspid valve intervention.
Copyright © 2025. Published by Elsevier B.V.
Conflict of interest statement
Declaration of competing interest M. Adamo received speaker honoraria from Abbott vascular and Edwards Lifesciences. M. Pagnesi received personal fees from Abbott, AstraZeneca, Boehringer Ingelheim, Novartis, Roche Diagnostics and Vifor Pharma. M. Andreas is proctor/consultant/speaker (Edwards, Abbott, Medtronic, Boston, Zoll), and received institutional research grants (Edwards, Abbott, Medtronic, LSI). P. Denti received speaker honoraria from peaker Honoraria: Abbott and is consultant for Approxima, HVR, InnovHeart, Picardia, Simulands. J. Dreyfus has received consulting fees from Abbott. R. Estevez-Loureiro is consultant for Abbott Vascular, Boston scientific and Edwards Lifesciences. R. Hahn reports speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, and Philips Healthcare; she has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Boston Scientific, Edwards Lifesciences, Medtronic and Novartis; and is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. J. Hausleiter has received speaker's honoraria and advisory board activities for Edwards Lifescience E. Ho has institutional consulting contracts for which he receives no direct compensation with Edwards Lifesciences and GE; he has served as an advisor for Medtronic, Abbott, Shifamed, Neochord, Half Moon, Vdyne, Anteris, Nyra, Meocor, Valgen. D. Kalbacher has received personal fees from Abbott Medical, Edwards Lifesciences, Pi-Cardio Ltd. And Metronic Inc. A. Latib has served on advisory boards or as a consultant for Medtronic, Boston Scientific, Philips, Edwards Lifesciences, Abbott, Shifamed, Neochord, Nyra Medical, Coramaze, V-dyne, Tri-Cares and Laplace. P. Lurz has received institutional fees and research grants from Abbott Vascular, Edwards Lifesciences, and ReCor, honoraria from Edwards Lifesciences, Abbott Medical, Innoventric, ReCor and Boehringer Ingelheim and has stock options with Innoventric. F. Maisano is a consultant for Abbott Vascular, Medtronic, Edwards Lifesciences, Perifect, Xeltis, Transseptal Solutions, Magenta and Cardiovalve, has received grant support from Abbott Vascular, Medtronic, Edwards Lifesciences, Biotronik, and Boston Scientific, NVT,Terumo, has received royalties from Edwards Lifesciences and 4Tech, and is co-founder/shareholder of Transseptal Solutions, 4Tech,Cardiovalve,Magenta,Perifect; Coregard and SwissVortex. D. Messika research grants from Edwards Lifesciences, Consultant for Predisurge. M. Metra has received consulting fees from Abbott Vascular, Actelion, Amgen, AstraZeneca, Bayer, Edwards Therapeutics, Livanova, Servier, Vifor Pharma, and WindTree Therapeutics. G. Nickenig received honoraria for lectures or advisory boards from Abbott, Boston Scientific, Edwards, Medtronic. G. Russo received fellowship training grant from EAPCI, sponsored by Edwards Lifesciences. J. Schofer is consultant of Edwards Lifescience. H. Sievert received Study honoraria to institution, travel expenses, consulting fees: 4tech Cardio, Abbott, Ablative Solutions, Adona Medical, Akura Medical, Ancora Heart, Append Medical, Axon, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Cardiac Dimensions, Cardiac Success, Cardimed, Cardionovum, Celonova, Contego, Coramaze, Croivalve, CSL Behring LLC, CVRx, Dinova, Edwards, Endobar, Endologix, Endomatic, Esperion Therapeutics, Inc., Hangzhou Nuomao Medtech, Holistick Medical, Intershunt, Intervene, K2, Laminar, Lifetech, Magenta, Maquet Getinge Group, Metavention, Mitralix, Mokita, Neurotronic, NXT Biomedical, Occlutech, Recor, Renal Guard, Shifamed, Terumo, Trisol, Vascular Dynamics, Vectorious Medtech, Venus, Venock, Vivasure Medical, Vvital Biomed, Whiteswell. G. Tang has received speaker's honoraria and served as a physician proctor, consultant, advisory board member, TAVR publications committee member, RESTORE study steering committee member, APOLLO trial screening committee member and IMPACT MR steering committee member for Medtronic, has received speaker's honoraria and served as a physician proctor, consultant, advisory board member and TRILUMINATE trial anatomic eligibility and publications committee member for Abbott Structural Heart, has served as an advisory board member for Boston Scientific and JenaValve, a consultant and physician screening committee member for Shockwave Medical, a consultant for NeoChord, Peija Medical and Shenqi Medical Technology, and has received speaker's honoraria from Siemens Healthineers. M. Taramasso reports consultancy fees from Abbott, Edwards Lifesciences, Medtronic, Boston Scientific, Shenqi Medical, Picardia, HiD Imaging, OneCrea, MEDIRA, CoreMedic, CoreQuest, Simulands, Cardiovalve. S. Von Bardeleben has served for trials and PI for Abbott, Edwards, Medtronic. J. Webb is consultant of Edwards Lifesciences and AtHeart. He has received research funding from Medtronic, Abbott, Boston scientific, Edwards Lifesciences. S. Windecker reports research, travel or educational grants to the institution from Abbott, Abiomed, Amgen, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Corflow Therapeutics, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Janssen-Cilag, Johnson & Johnson, Medicure, Medtronic, Merck Sharp & Dohm, Miracor Medical, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pfizer, Polares, Regeneron, Sanofi-Aventis, Servier, Sinomed, Terumo, Vifor, V-Wave. Stephan Windecker serves as advisory board member and/or member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Astra Zeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, Janssen, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, V-Wave and Xeltis with payments to the institution but no personal payments. He is also member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. The other authors do not have relevant conflict to disclose.
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