Transcatheter Tricuspid Repair Cuts Death
The TRIC-I-HF trial shows transcatheter tricuspid valve repair significantly reduces all-cause death and heart failure hospitalization in high-risk
Transcatheter tricuspid valve repair significantly reduces death and hospitalization in high-risk patients with severe regurgitation. The TRIC-I-HF trial, presented at the European Society of Cardiology Congress and published in the New England Journal of Medicine, found a win ratio of 2.42 for the intervention over medical therapy alone at one year.
Jörg Hausleiter, MD, of Ludwig-Maximilians-Universität München, Germany, led the study. It involved 360 patients with symptomatic severe tricuspid regurgitation, randomized at 29 German heart-valve centers.
Trial Design and Patient Population
Patients were assigned in a 2:1 ratio to receive either transcatheter repair or medical therapy alone. The average age was 80.3 years, and 56.4% were women. The cohort had advanced disease at enrollment.
| TR Severity at Baseline | Percentage of Patients |
|---|---|
| Severe | 50.8% |
| Massive | 34.2% |
| Torrential | 10.3% |
Three-quarters of participants had New York Heart Association class III or IV heart failure. Furthermore, 55.0% had been hospitalized for heart failure in the year before joining the trial. The average left ventricular ejection fraction was 54.3%.
Key Clinical Outcomes
The primary benefit was a sharp reduction in hard clinical outcomes. At three years, the combined rate of death from any cause and heart failure hospitalization was 52.4% for the medical therapy group versus 21.0% for the repair group. This represents a hazard ratio of 0.40.
The benefit for heart failure hospitalization appeared early, at an average of 1.6 years. It continued to grow over time. The number needed to treat to prevent one death or heart failure hospitalization at one year was just four patients.
Procedural safety was also demonstrated. Major adverse events within 30 days occurred in 5.9% of patients who underwent the transcatheter repair.
Procedure Details and Expert Reaction
Nearly all interventions used the transcatheter edge-to-edge repair technique. The specific CE-marked devices employed were the Pascal and TriClip systems.
| Device Used for TEER | Percentage of Cases |
|---|---|
| Pascal | 65.6% |
| TriClip | 33.0% |
The trial allowed crossovers from medical therapy to intervention only after severe heart failure decompensation requiring hospitalization and IV diuretics. In 28 of 48 crossover cases, the repair was performed during the hospitalization that itself counted as a primary endpoint event.
Rebecca Hahn, MD, of Columbia University Medical Center, served as the ESC session discussant. She called TRIC-I-HF a landmark study. "I congratulate the investigators in proving for once and for all that TR reduction can result in a mortality and heart failure hospitalization benefit," Hahn stated.
The investigators attributed the trial's success to its sicker patient population and the growing real-world experience of operators at high-volume centers. They noted the procedure remains technically demanding, with a pronounced relationship between operator volume and outcomes.
Hausleiter emphasized the value of quality of life gains, which were part of the win ratio calculation. He noted that for many elderly patients, improving daily life may matter more than extending lifespan. The full findings, according to the study authors, extend past evidence by showing benefits beyond quality of life to include meaningful differences in hard clinical outcomes.
