Patients with significant tricuspid regurgitation (TR) at intermediate disease stage were more likely to survive at one year when treated via tricuspid transcatheter edge-to-edge-repair (T-TEER) when compared to patients treated conservatively, according to a study published Feb. 10 in JACC: Cardiovascular Interventions. This survival benefit was not observed in patients at early or advanced stages of disease.

Florian Schlotter, MD, et al., included 1,885 patients with significant TR from the European Registry of Transcatheter Repair for Tricuspid Regurgitation (EuroTR), grouping them by early (21%), intermediate (62%) and advanced (17%) disease stages. Disease categories were determined by left and right ventricular function, renal function and natriuretic peptide levels. Of the total number of patients analyzed, 585 were conservatively treated while 1,300 underwent T-TEER.

The primary outcome of the study was one-year mortality. The authors found no significant difference in mortality rate between interventional and conservative treatment groups among patients with early and advanced disease (early-stage hazard ratio [HR], 0.78; 95% CI, 0.34-1.80; p=0.54; advanced-stage HR, 1.06; 95% CI, 0.71-1.60; p=0.78). However, among patients with intermediate disease, mortality was significantly lower in patients in the interventional treatment group (HR, 0.73; 95% CI, 0.52-0.99; p=0.03).

The authors note that within the T-TEER cohort, residual TR differed across disease stages. Patients who presented with more advanced TR experienced higher rates of worse residual TR (increase of residual TR grade ≥3: 16% for early, 17% for intermediate, 23% for advanced; p=0.02).

"Although anatomical criteria for procedural success are well established, recently it was suggested that patients who have higher stressed blood volumes,” write the authors, blood volume generating intravascular pressure, “might be prone to lower reductions in central venous pressure, even in the context of procedural success, thereby limiting the clinical benefit."

In an accompanying editorial comment, Firas E. Zahr, MD, FACC, and Scott M. Chadderdon, MD, FACC, write: "A salient finding of the study is the demonstration of a possible mortality benefit in the newly defined 'intermediate disease stage' of severe symptomatic TR, offering compelling evidence of a 'sweet spot' at which early mortality benefits may be achievable."