Introduction: Tricuspid regurgitation (TR) is an underdiagnosed valvular heart disease, more frequent in patients over 75 years of age, associated with higher mortality and poorer quality of life. The secondary form represents up to 90% of cases. Its detection is usually late, limiting surgical treatment. Transcatheter repair has shown good results in reduction of TR and functional improvement. This study retrospectively analyses the characteristics and clinical evolution of patients with severe TR (STR) treated in Hospital Central de Asturias by transcatheter repair or surgical intervention between 2018 and 2023.
Results: Regarding the baseline characteristics of the patients, no differences were found between both groups (Table 1 ), only patients undergoing transcatheter repair had a higher mean age (77.1 vs 57.2 years) and higher prevalence of atrial fibrillation (p=0.007). No significant differences were found in other clinical antecedents or in the use of previous medical treatment (Table 2). Functional aetiology predominated in the transcatheter repair group, while in the surgical group it was mostly primary (p=0.048). Echocardiographically, patients in the transcatheter repair group had a greater degree of dilatation of the right ventricle and atrium; however, right ventricular function was similar in both groups as measured by TAPSE. Pulmonary artery systolic pressure was significantly higher in the surgical group (p 0.0162). At one year, treatment success was greater in the surgical group (75% with mild insufficiency) compared to the transcatheter group (31.6%). There was no mortality at 30 days or at one year. No significant differences were found in readmissions for heart failure or in the need for adjustment of diuretic treatment after the intervention.
Conclusion: Patients who underwent transcatheter repair were older and had more comorbidities, with a predominance of secondary aetiology, whereas surgery was predominantly primary. Surgery was more successful in reducing the severity of valvular heart disease; however, transcatheter repair reduced the severity of TR to at least moderate in 63% of patients. In most patients, the intervention did not reduce the dose of diuretic treatment (Table 2). There was no difference in mortality or rehospitalisation at one year. Current evidence supports transcatheter repair as a complementary pillar to pharmacological treatment of STR.
