PATIENT SELECTION AND OUTCOMES OF TRANSCATHETER TRICUSPID VALVE INTERVENTIONS WITH A DEDICATED HEART TEAM

Background and Aim: Transcatheter procedures for the treatment of tricuspid valve regurgitation have been introduced as a valuable tool for the treatment of high-risk patients. Methods: Sixteen patients (2021-2024; median age 82 y.o, 70% female) with significant tricuspid regurgitation underwent transcatheter treatment. A dedicated structural valve team has been established for patient selection, treatment and strict follow-up. Results: All cases enrolled were considered at high-prohibitive surgical risk (Median TRI- SCORE 28%, range 8-64%). A strict evaluation of RV function was carried out with echocardiography and right heart catheterization. Device selection has been carried out according anatomic criteria, coaptation gap and main jet location. Nine patients presented a coaptation gap < 8.5 mm and were treated with edge-to-edge repair, three case exhibited severe annular dilation and were treated with annuloplasty and four remaining cases (not suitable for leaflets or annular techniques) were treated with etherotopic valve implantation. Procedural success was achieved in 93% of cases. Three patients died at 30 days, one for acute right heart failure, one for respiratory failure and a third for pneumonia. A significant improvement of functional status was reported at follow up intervals of 3-6 and 12 months (NYHA class 3±0.5 vs 1.5±0.5). Among patients who completed 1-year follow-up (75%) no late death or rehospitalization for heart failure were detected. Conclusions: Transcatheter tricuspid valve interventions represent a needed tool in the hands of the modern cardiac surgeon. Patient’s selection and surgical risk assessment are crucial to optimize outcome.