Comparison of Transcatheter Versus Surgical Tricuspid Repair Among Patients With Tricuspid Regurgitation: Two-Year Results

Tomonari M. Shimoda, Hiroki A. Ueyama, Yoshihisa Miyamoto, Atsuyuki Watanabe, Hiroshi Gotanda, Dhaval Kolte, Azeem Latib, Tsuyoshi Kaneko, Alan Zajarias, Sammy Elmariah, Hiroo Takayama, Yusuke Tsugawa, Toshiki Kuno

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

BACKGROUND: Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. We aimed to compare outcomes between these 2 approaches. METHODS: We analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention. A propensity score matching weight analysis was used to adjust for potential confounders. RESULTS: A total of 1143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. After adjustment for potential confounders, we found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair (adjusted hazard ratio, 0.84 [95% CI, 0.63-1.13]). Patients treated with T-TEER experienced lower in-hospital mortality (2.5% versus 12.5%, P<0.001) and permanent pacemaker implantation rates (0.0% versus 12.7%, P<0.001) than those treated by surgical repair. At 2 years, we found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group (subdistribution hazard ratio, 8.03 [95% CI, 2.87-22.48]). CONCLUSIONS: Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy.

Original languageEnglish
Pages (from-to)e014825
JournalCirculation: Cardiovascular Interventions
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2025

Keywords

  • Medicare
  • catheters
  • heart failure
  • mortality
  • tricuspid valve

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