Background

Transcatheter tricuspid valve intervention (TTVI) has significantly extended the access to treatment options for tricuspid regurgitation (TR). However, a sizeable proportion of patients is still declined for TTVI and little is known about the characteristics of this population.

Methods

547 patients evaluated between 01/2016-12/2021 from 3 centers in the US and Germany were included. Clinical records and transthoracic/transoesophageal echocardiography studies were used to assess health-status and morphologic characteristics of the right ventricle (RV) and the tricuspid valve (TV).

Results

Patients´ median age was 80 (74-83) years and 60% were female. Over half (n=318, 58.1%) were accepted for TTVI. Among those who were deemed unsuitable (n=229, 41.9%), anatomical criteria (n=130, 56.8%), and primarily overt RV and TV enlargement, was the most common reason for TTVI rejection (Figure 1). In regression analysis, RV and right atrial sizes, TV coaptation gap and tethering area were identified as independent screen failure predictors (p<0.05 for all). Other reasons for rejection included clinical futility (n=41, 17.9%), low symptomatic burden (n=29, 12.7%), and technical limitations (n=29, 12.7%). Most (n=164, 71.6%) received conservative/ medical treatment, and a small number either proceeded to surgery (n=51, 22.3%) or became eligible for a transcatheter TV replacement in new feasibility study in the US (n=14, 6.1%).

Conclusion

The majority of TTVI screen failure patients are rejected because of overt TV and RV enlargement. However, a significant proportion are rejected because of clinical futility. These anatomical and clinical characteristics emphasize the importance of earlier referral and intervention of symptomatic TR.