Abstract 4141252: Transcatheter versus Surgical Tricuspid Repair among Medicare Beneficiaries: One-Year Results

Background: Mid-term comparative evidence on transcatheter versus surgical tricuspid valve repair is limited at the national level. Objective: We aimed to evaluate the in-hospital and 1-year outcomes of transcatheter edge-to-edge repair (TV-TEER) versus surgical repair among Medicare beneficiaries. Methods: We analyzed the national data on Medicare beneficiaries aged ≥65 who underwent TV-TEER or isolated surgical tricuspid repair between January 2016 and December 2021. The outcomes of interest included in-hospital mortality, permanent pacemaker implantation rates, and 1-year all-cause mortality and major adverse cardiovascular events (MACE). MACE comprised all-cause mortality, heart failure hospitalization, stroke, and tricuspid reinterventions. We computed propensity scores for undergoing TV-TEER or surgical repair and a matching weight analysis was conducted to compare the two groups. Results: A total of 2,257 patients were included (TV-TEER= 1,063 patients, surgical repair = 1,194 patients). The annual volume of TV-TEER cases increased from 20 in 2016 to 307 in 2021 while the annual volume of surgical cases decreased from 233 cases to 156 cases (Figure A). In the unadjusted cohort, TV-TEER was associated with lower in-hospital and 1-year mortality rates (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.70-0.99; P=0.03). Adjusted in-hospital mortality was also significantly lower in the TV-TEER group compared to the surgical repair group (2.2% vs. 14.2%, P<0.001). Additionally, TV-TEER was associated with lower 1-year all-cause mortality compared to surgical repair (adjusted HR, 0.75; 95% CI, 0.61-0.92; P=0.007) (Figure B). MACE was also lower in the TV-TEER group at 1 year (adjusted HR, 0.73; 95% CI, 0.60-0.88; P<0.001). TV-TEER also resulted in fewer post-treatment permanent pacemaker implantations (0.5% vs. 14.0%, P<0.001) after adjustment. Conclusions: Among Medicare beneficiaries undergoing TV-TEER or surgical repair, TV-TEER was associated with more favorable in-hospital and 1-year outcomes compared to surgical repair. While a rapid increase in TV-TEER cases was observed, further validation of mid-term outcomes is essential to ensure proper patient selection.