https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 3Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 5Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 6Universitätsklinikum Köln Herzzentrum - Kardiologie Köln, Deutschland; 7Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
Background:
Severe tricuspid regurgitation (TR) causes debilitating symptoms, significantly impacting quality of live. Direct transcatheter tricuspid valve annuloplasty (TTVA) broadens the treatment options for TR and offers an alternative to tricuspid valve transcatheter edge-to-edge repair. However, the impact of sex on outcomes following TTVA remains unclear.
Methods:
This multicenter study included consecutive patients who underwent TTVA at three high-volume centers in Germany between 2018 and 2023. Outcomes, stratified by sex, included procedural and device success as defined by the Tricuspid Valve Academic Research Consortium (TVARC), TR reduction to ≤2+, changes in New York Heart Association (NYHA) functional class, and 1-year survival.
Results:
A total of 224 patients were analyzed, with 172 females (76.8%) and 52 males (23.2%). Female patients were older (80 [75-83] vs. 77 [72-81] years, p=0.024), had higher left ventricular ejection fractions (56 [52-61] vs. 53 [48-57] %, p=0.002), smaller right ventricular basal diameters (46 [42-52] vs. 50 [45-56] mm, p=0.001), and lower right atrial pressures (14 [10-17] vs. 16 [12-20] mmHg, p=0.048). The TRI-SCORE was similar between sexes (5 [4-6] vs. 5 [5-7], p=0.281). Baseline characteristics showed comparable TR grade 4+/5+ (68% vs. 57.7%, p=0.227) and NYHA class III/IV status (86.5% vs. 90%, p=0.819). Rates of TVARC technical success (98.3% vs. 100%, p=0.787) and device success (73.1% vs. 84.4%, p=0.171) were similar between sexes. TR ≤2+ was achieved in 61.7% of female and 72% of male patients (p=0.243), with NYHA class improvement by at least one class in 64.2% of females and 64.9% of males (p>0.999). One-year survival was 86.5% (95% CI: 80.7-92.6%) in females and 77.3% (95% CI: 65.5-91.2%) in males (p=0.16).
Conclusion:
Direct TTVA is more commonly performed in female patients, who constitute approximately three-quarters of the cohort. In both sexes, procedural and device success, TR reduction to ≤2+, and NYHA class improvements were achieved at similar rates, with comparable 1-year survival outcomes. These findings suggest that TTVA offers a viable treatment option for severe TR in both male and female patients.