#Transcatheter valve replacement best for severe tricuspid regurgitation

Transcatheter tricuspid-valve replacement is superior to medical therapy alone for patients with severe tricuspid regurgitation, according to a study published online Oct. 30 in the New England Journal of Medicine to coincide with the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to 30 in Washington, D.C.

Rebecca T. Hahn, M.D., from the Columbia University Irving Medical Center in New York City, and colleagues randomly assigned 400 patients with severe symptomatic tricuspid regurgitation to undergo transcatheter tricuspid-valve replacement and medical therapy (valve-replacement group) or medical therapy alone (control group; 267 and 133 patients, respectively). All possible patient pairs were compared to calculate the win ratio for the primary outcome.

The researchers found that the win ratio favoring valve replacement was 2.02 at one year. More wins occurred among patients in the valve-replacement group versus the control group with respect to death from any cause (14.8 versus 12.5%), postindex tricuspid-valve intervention (3.2 versus 0.6%), and improvement in the Kansas City Cardiomyopathy Questionnaire overall summary score (23.1 versus 6.0%), New York Heart Association functional class (10.2 versus 0.8%), and six-minute walk distance (1.1 versus 0.9%).

With respect to the annualized rate of hospitalization for heart failure, the valve-replacement group had fewer wins than the control group (9.7 versus 10.0%). Severe bleeding occurred in 15.4 and 5.3% of the valve-replacement and control groups, respectively.

“In patients with severe tricuspid regurgitation, transcatheter tricuspid-valve replacement plus medical therapy was superior to medical therapy alone,” the authors write.

The study was funded by Edwards Lifesciences.

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