One-Year Outcomes of Screen Failures for Transcatheter Tricuspid Valve Repair: Insights From the TriSelect Study

BACKGROUND: Observational registries have shown improved survival among patients with severe or greater tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve repair (TTVr) compared with conservative management. However, it remains unclear whether this survival benefit persists when specifically comparing patients undergoing TTVr with those who screen failed. METHODS: We conducted a retrospective analysis of 547 patients from the TriSelect registry evaluated for TTVr—either transcatheter tricuspid valve edge-to-edge repair or direct transcatheter tricuspid valve annuloplasty at 3 tertiary centers in the United States and Germany between 2016 and 2021. The end point of 1-year survival was stratified by treatment group (TTVr versus screen fail) and procedural success (residual TR ≤ moderate versus > moderate). RESULTS: Of the 547 patients, 219 (41.9%) screen failed and 318 (58.1%) underwent TTVr (transcatheter tricuspid valve edge-to-edge repair, 61.6%; transcatheter tricuspid valve annuloplasty, 38.4%). Among treated patients, 224 (70.4%) achieved residual TR ≤ moderate. Unadjusted Kaplan-Meier–derived 1-year survival was significantly higher in patients who underwent TTVr compared with screen-fail patients (82.5% versus 68.4%, log-rank P <0.001). In multivariable Cox proportional hazards analysis, treatment with TTVr was independently associated with lower 1-year mortality (hazard ratio, 0.40 [95% CI, 0.18–0.86]; P =0.020). Among treated patients, survival was significantly higher in those with residual TR ≤ moderate versus those with greater than moderate residual TR (88.0% versus 69.2%, unadjusted log-rank P =0.005). Notably, in patients with residual TR > moderate, there was no survival benefit compared with screen-fail patients (unadjusted log-rank P =0.74). CONCLUSIONS: In this registry-based analysis, TTVr was associated with improved 1-year survival compared with screen-fail patients, but only when TR was reduced to moderate or less. These findings highlight the critical importance of achieving procedural success with a TTVr along with early referral and transcatheter tricuspid valve intervention device selection.