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Right heart failure and mortality in patients undergoing transcatheter tricuspid valve interventions.

International journal of cardiology

Authors: Edoardo Pancaldi, Marianna Adamo, Matteo Pagnesi, Giulio Russo, Hannes Alessandrini, Martin Andreas, Daniel Braun, Dario Cani, Kim A Connelly, Paolo Denti, Rodrigo Estevez-Loureiro, Neil Fam, Rebecca T Hahn, Claudia Harr, Joerg Hausleiter, Dominique Himbert, Daniel Kalbacher, Edwin Ho, Azeem Latib, Edith Lubos, Sebastian Ludwig, Philipp Lurz, Vanessa Monivas, Georg Nickenig, Daniela Pedicino, Giovanni Pedrazzini, Fabien Praz, Joseph Rodes-Cabau, Christian Besler, Anne Rebecca Schöber, Joachim Schofer, Andrea Scotti, Kerstin Piayda, Horst Sievert, Gilbert H L Tang, David Messika-Zeitoun, Holger Thiele, Florian Schlotter, Ralph Stephan von Bardeleben, John Webb, Julien Dreyfus, Stephan Windecker, Martin Leon, Francesco Maisano, Marco Metra, Maurizio Taramasso

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.

Copyright © 2025. Published by Elsevier B.V.

PMID: 40068787

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