Evolution of treatment for isolated tricuspid regurgitation in the transcatheter era

Abstract Background Tricuspid regurgitation has historically been neglected or treated too late. Outcomes of tricuspid surgery have been plagued by high mortality. Recently, transcatheter therapies have emerged as a promising alternative. Aims To assess the changes in tricuspid regurgitation patients’ referral, treatment, and in-hospital outcomes before and after transcatheter technologies became established at our centre. Methods and results We retrospectively reviewed our in-hospital data from patients with isolated ≥moderate-to-severe tricuspid regurgitation referred for correction between January 2012 and December 2023. We compared two periods: before (2012–2017) and after (2018–2023) the widespread adoption of transcatheter procedures. A total of 348 patients were referred. Admissions rose from 108 (2012–2017) to 240 (2018–2023), reflecting a +12.4% annual growth (P < .001). Surgical treatment decreased from 68.5% to 37% (P < .001), while transcatheter interventions increased from 3.7% to 44% (P < .001) and indication to medical therapy alone declined from 27.8% to 19% (P = .046). Patients’ risk profile remained similar over time (TriScore 7% vs 8%, P = .64). In-hospital mortality for tricuspid correction dropped from 10.3% to 3.6% (P = .039), but residual regurgitation ≥3+ rose from 2.6% to 16.3% (P < .001). Conclusions After the advent of transcatheter therapies, more patients with isolated tricuspid regurgitation were referred and received correction. In the last years, transcatheter therapies became the most used method to treat tricuspid regurgitation. Procedural mortality fell, however residual regurgitation was more common. Patients’ risk profile remained similar.