Transcatheter Tricuspid Valve Replacement Versus Totally Thoracoscopic Beating-Heart Surgery for Tricuspid Regurgitation.

Purpose: Totally thoracoscopic and beating-heart techniques used in tricuspid valve surgery (TTC-TVS) show favorable outcomes. Transcatheter tricuspid valve replacement (TTVR) is an increasingly utilized alternative for patients with tricuspid regurgitation (TR) at high surgical risk. The purpose of this study was to compare TTVR with TTC-TVS to examine the outcomes of these two different management protocols for patients with symptomatic severe TR.

Methods: A total of 116 patients with symptomatic severe TR were retrospectively collected and divided into the TTVR (n = 38) and the TTC-TVS (n = 78) groups. The primary end points included 2-year all-cause mortality and the combined endpoint (all-cause mortality and hospitalizations for heart failure).

Results: At a median follow-up of 630 (IQR 450-720) days, the similar freedom from 2-year all-cause mortality (85.2% vs. 70.8%; log-rank P = 0.13) and different freedom from combined endpoint (75.3% vs. 49.8%; log-rank P = 0.0049) were followed in TTVR and TTC-TVS. After stratification by TRI-SCORE, TTVR subgroups showed significant difference in combined endpoint, and both also showed significant difference compared to the corresponding TTC-TVS subgroups (all log-rank P < 0.05). In multivariate Cox regression analysis, TRI-SCORE ≥ 6 was independently correlated with all-cause mortality (HR 3.913, 95% CI 1.481-10.337; P = 0.006) and combined endpoint (HR 4.070, 95% CI 1.924-8.608; P < 0.001).

Conclusions: TTVR may offer greater benefit compared to TTC-TVS for sicker patients with severe TR. However, this observation should be interpreted within a specific clinical context emphasizing the importance of early intervention.