Tricuspid Transcatheter-Edge-to-Edge-Repair and Transcatheter Tricuspid Valve Replacement for Tricuspid Regurgitation: Patient Profiles and Outcomes

<h2>Abstract</h2><h3>Background</h3> Transcatheter tricuspid valve replacement (TTVR) is typically reserved for patients in whom tricuspid valve transcatheter edge-to-edge repair (T-TEER) is deemed unsuitable or unlikely to provide effective treatment. Comparative data evaluating patient profiles, disease stage, and outcomes between T-TEER and TTVR are limited. We aimed to analyze and compare patient profiles, selection, and outcomes with either T-TEER or TTVR. <h3>Methods</h3> A total of 43 consecutive patients from May 2018 to April 2023 were retrospectively divided into 2 groups: Group-1 underwent T-TEER; and Group-2 underwent TTVR. Primary endpoints are as follows: inpatient mortality; and 30-day and 12-month mortality. Secondary endpoints are as follows: echocardiographic tricuspid regurgitationgrading; new pacemaker implantation; and heart failure-related readmissions at 30 days and 12 months. <h3>Results</h3> A total of 43 patients underwent intervention (T-TEER, n=14; TTVR, n=29;). The mean age was 77.6 ± 10.3 years, and 38 patients (88%) were diagnosed with functional tricuspid regurgitation. The in-hospital mortality rate was 7%; the 30-day mortality rate was 12% with heart failure readmission for 14%.The 12-month mortality rate was 33%, with heart failure readmission for 37%. No in-hospital or 30-day mortality occurred in the T-TEER group. The 12-month mortality rate was 29% in the T-TEER group vs 34% in the TTVR group. The TTVR cohort showed numerically younger patients (76.2 ± 10.6 vs 80.4 ± 9.6 years, <i>P</i> = 0.24) and numerically higher TRI-scores (for tricuspid; 6.0, interquartile range [IQR], 4.0-7.0 vs 4.5, 1.5-5.75, <i>P</i> = 0.09). The calculated GLIDE-score (<b>g</b>ap, <b>l</b>ocation, <b>i</b>mage quality, <b>d</b>ensity, <b>e</b>n-face TR morphology) was significantly lower in the T-TEER cohort (<i>P</i> < 0.01). The length of hospitalization was significantly longer in the TTVR group (1, interquartile range, 1-4 vs 1, 1-1; <i>P</i> = 0.02). <h3>Conclusions</h3> Our findings suggest that patients undergoing T-TEER vs TTVR may represent different disease stages. Further data are required to determine the best patient selection for T-TEER vs TTVR to optimize patient outcomes.