Applying the 2025 ESC/EACTS Recommendations for the Treatment of Severe Tricuspid Regurgitation to Real-World Practice

BACKGROUND: According to the 2025 ESC/EACTS guidelines for the management of valvular heart disease, transcatheter tricuspid valve interventions (TTVI) have received a Class IIa recommendation (Level of Evidence: A) for the treatment of patients with severe symptomatic tricuspid regurgitation. However, in patients with severe left ventricular dysfunction (LVD) or right ventricular dysfunction (RVD) or precapillary pulmonary hypertension (pcPH), optimal medical therapy (OMT) is preferred because of the potential risk for futility. OBJECTIVES: The aim of this study was to evaluate clinical and symptomatic outcomes in such "OMT candidate" patients. METHODS: Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting ≥1 exclusion criterion ("OMT candidates") were compared with those meeting current recommendations ("TTVI appropriate") regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH). RESULTS: Among 1,626 T-TEER patients, 213 (13.1%) met ≥1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of ≥1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, "OMT candidates" had lower HFH-free survival than "TTVI-appropriate" patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (≥1 NYHA functional class in 56.2% vs 59.5%; P = 0.68). CONCLUSIONS: T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.

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Journal
JACC: Cardiovascular Interventions
Published
2026-04-01
DOI
https://doi.org/10.1016/j.jcin.2026.02.024
Citations
1
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
19.37
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article

Applying the 2025 ESC/EACTS Recommendations for the Treatment of Severe Tricuspid Regurgitation to Real-World Practice

Edoardo Pancaldi, Dominik Felbel, Martijn G. H. Vrijkorte, Cand Med et al.
1 citations
JACC: Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
19.37
article

Applying the 2025 ESC/EACTS Recommendations for the Treatment of Severe Tricuspid Regurgitation to Real-World Practice

Edoardo Pancaldi, Dominik Felbel, Martijn G. H. Vrijkorte, Cand Med, Vera Fortmeier, Sebastian Rosch, Jennifer von Stein, Thorald Stolte, Philipp M. Doldi, Federico Arturi, Amin Polzin, Mirjam Gauri Wild, Nicole Karam, Hazem Omran, Karl‐Patrik Kresoja, Christian Besler, Florian Schindhelm, Mathias H. Konstandin, Harald Lapp, Cristina Giannini, Marco Metra, Alessandro Sticchi, Natacha Rousse, Julia Grapsa, Benedikt Koell, Martin J. Swaans, Lukas Stolz, Elisa Pezzola, Stefan Toggweiler, Tiffany Patterson, Daniel Kalbacher, Andreas Goldschmied, Matteo Mazzola, Stephanie K. Brunner, Philipp Lauten, Christoph Pauschinger, Samy Aghezzaf, Ludwig T. Weckbach, Charlotte Wolff, Eric Van Belle, Leonhard‐Moritz Schneider, H.‐G. Thiele, Leonie Ziegler, Katalin Berschiminski, P H I L I P Lurz, Bjoern Goebel, Kaspar Volz, Karl-Philip Rommel, Manuel Barreiro-Perez, Enrique Sánchez-Muñóz, Quentin de Baynast, Fabian Voss, Amir Abbas Mahabadi, Tomas Benito-Gonzalez, P A Achouh, F Praz, M Adamo, F Bedogni, A Popolo Rubbio, C Iliadis, Mirjam Kessler, Sebastian Ludwig, Paolo Denti, Martin Kraus, Giulia Masiero, Roman Pfister, Muhammed Gerçek, Flavien Vincent, Alain Berrebi, Francesco Maisano, Peter Boekstegers, Tobias Geisler, Philipp von Stein, Andreas Rück, Hannah Kempton, Carsten Salomon, Mauro Massussi, Felix Rudolph, Julio Echarte-Morales, Giuseppe Tarantini, Marco De Carlo, Thomas J. Stocker, Wolfgang Rottbauer, Philipp Schlegel, Volker Rudolph, Mohammad Kassar, Tienush Rassaf, Dirk Westermann, Jörg Hausleiter, Norbert Frey, Julia Novotny, Thomas Nestelberger, Stephan Baldus, Laura Lupi, Berenice Caneiro-Queija, Rodrigo Estévez-Loureiro, Monika Zdanyte, Tobias Kister, Ralph Stephan von Bardeleben
article en
1 citations

Abstract

BACKGROUND: According to the 2025 ESC/EACTS guidelines for the management of valvular heart disease, transcatheter tricuspid valve interventions (TTVI) have received a Class IIa recommendation (Level of Evidence: A) for the treatment of patients with severe symptomatic tricuspid regurgitation. However, in patients with severe left ventricular dysfunction (LVD) or right ventricular dysfunction (RVD) or precapillary pulmonary hypertension (pcPH), optimal medical therapy (OMT) is preferred because of the potential risk for futility. OBJECTIVES: The aim of this study was to evaluate clinical and symptomatic outcomes in such "OMT candidate" patients. METHODS: Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting ≥1 exclusion criterion ("OMT candidates") were compared with those meeting current recommendations ("TTVI appropriate") regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH). RESULTS: Among 1,626 T-TEER patients, 213 (13.1%) met ≥1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of ≥1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, "OMT candidates" had lower HFH-free survival than "TTVI-appropriate" patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (≥1 NYHA functional class in 56.2% vs 59.5%; P = 0.68). CONCLUSIONS: T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.

JACC: Cardiovascular InterventionsVol. 19(7)
University of Pisa (IT), University of Bern (CH), Brigham and Women's Hospital (US), Karolinska University Hospital (SE), University of Padua (IT), University of Cologne (DE), University of Basel (CH), Johannes Gutenberg University Mainz (DE), Guy's and St Thomas' NHS Foundation Trust (GB), Université Paris Cité (FR), Heidelberg University (DE), Heart and Diabetes Center North Rhine-Westphalia (DE), University Hospital of Bern (CH), University Hospital Heidelberg (DE), University Hospital Complex Of Vigo (ES), University Hospital of Basel (CH), Centre Hospitalier Universitaire de Lille (FR), LMU Klinikum (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Helios Hospital Siegburg (DE), IRCCS Policlinico San Donato (IT), Hôpital Européen Georges-Pompidou (FR), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), St. Antonius Ziekenhuis (NL), Zentralklinik Bad Berka (DE), Leipzig Heart Institute (DE), Luzerner Kantonsspital (CH), German Centre for Cardiovascular Research (DE), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Cologne (DE), West German Heart and Vascular Center Essen (DE), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Heinrich Heine University Düsseldorf (DE), University of Brescia (IT), Ludwig-Maximilians-Universität München (DE), Leipzig University (DE)
Openalex Percentile: Top 1%
Cardiac Valve Diseases and Treatments
19.37
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