Early portuguese experience with TTVR: procedural and early outcomes

Introduction

Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising option for severe symptomatic tricuspid regurgitation (TR), but real-world data outside pivotal trials are still limited.

Purpose

To evaluate procedural and 30-day outcomes of TTVR in a real-world Portuguese cohort.

Methods

Retrospective, single-center study including consecutive patients undergoing TTVR, between October 2024 and October 2025. Baseline characteristics, procedural metrics, and early clinical outcomes were collected.

Results

Eighteen patients were included (median age 79.5 [IQR 10.0] years; 44.4% male). TR was severe in 27.8%, massive in 16.7%, and torrential in 55.6%. TR etiology was mixed primary/functional in 44.4%, followed by atrial/ventricular functional TR in 38.9%. Degenerative disease (5 cases), valve prolapse (2), and electrocatheter impingement (2) were the most frequent primary causes. Mean TRISCORE was 3.3±1.9, and 94.4% were in NYHA II–III. Median NT-proBNP was 1801.5 pg/mL (IQR 3084.8). Atrial fibrillation was present in 94.5%, and 16.7% had a previous pacemaker.

Baseline right ventricle (RV) function included mean fractional area change (FAC) 39.8±7.0%, TAPSE 17.8±4.1mm, RV strain −19.3±3.5%, and TAPSE/sPAP 0.44±0.12. Right heart catheterization was performed in 94.4%, revealing pulmonary hypertension in 12 patients (27.8% precapillary, 22.2% postcapillary, 16.7% combined). Mean pulmonary artery pressure was 23.6±6.3mmHg and PCWP 15.6±5.7mmHg.

Median procedural duration was 112.5 minutes (IQR 33.8). The 52-mm valve was the most used (38.9%). TR reduction was achieved in all patients: none/trace in 33.3%, mild in 55.6%, and moderate in 11.1%. Mean transprosthetic gradient was 3.2±1.1mmHg. Post-operative worsening of RV function was observed: RV strain −12.4±3.7% (p<0.001), TAPSE 10.9±3.9mm (p<0.001), and FAC 25.4±7.6% (p<0.001). Procedural complications included one cardiac tamponade and one acute heart failure requiring inotropes. No in-hospital mortality occurred. Median hospitalization was 4.5 days (IQR 2.3).

At 30 days, two patients required pacemaker implantation for complete heart block (2/15 patients, 13.3%), two were rehospitalized for heart failure (11.1%), one had a transient ischemic attack, and one was hospitalized for access-site hematoma.

Conclusions

Our center experience aligns with TRISCEND-II, supporting the safety and efficacy of TTVR in real-world practice. Notably, the pacemaker implantation rate was substantially lower than the 24.7% reported in TRISCEND-II. These findings reinforce the expanding role of TTVR as a viable therapeutic option for severe symptomatic TR.TR reductionFor image description, please refer to the figure legend and surrounding text.