Tricuspid regurgitation (TR) is a condition whose prevalence is expected to increase in the coming years. Surgery presents important challenges and is associated with a non-negligible mortality rate.
Percutaneous treatment is emerging as a valid alternative in this scenario, especially in patients at high surgical risk, either through valve implantation or heterotopic approaches such as the bicaval TricValve system.
Currently, the available evidence is limited and mainly based on studies such as TRICUS and TRICUS EURO.
An analysis of the TriBicaval Registry was performed, including 204 patients with severe, massive, or torrential TR, symptomatic, and at high surgical risk.
The primary endpoint (PEP) at one year was a composite of functional class and systemic venous congestion (peripheral edema and ascites), together with the rate of rehospitalization for heart failure compared with the previous year.
The mean age was 77 years; 65% were women; mean TRI-SCORE was 14%. Comorbidities were highly prevalent: hypertension (88%), diabetes (20%), impaired renal function (72%), dialysis (2.5%), stroke/TIA (2.5%), previous cardiac surgery (50%), prior percutaneous treatment on the tricuspid valve (9%), and pacemaker/ICD/CRT (34%). Heart failure hospitalization within the last year was observed in 61%, and atrial fibrillation was very frequent (95%).
Regarding TR severity, torrential regurgitation was most common (49%), followed by massive and, less frequently, severe TR. The most frequent etiology was ventricular secondary TR (42%), followed by atrial secondary TR (37%), while catheter-related and primary causes were less frequent. All patients were in NYHA class III or IV.
Technical success was achieved in 96.1% and clinical success in 83%.
At 30 days, overall mortality was 8.3%, cardiac mortality 7.3%, reintervention 0.5%, major bleeding 1.3%, and vascular complications 5.4%.
Read also: Edge-To-Edge Treatment with PASCAL: Are There Sex-Specific Differences?
At one year, the PEP occurred in 19.1% of patients, and all-cause mortality was 22.7%. According to TRI-SCORE, mortality was 6.7% when the score was 0–3 (95% CI: 1.7%–24.6%), 23.4% with scores of 4–5 (95% CI: 14.4%–36.7%), and 28.8% when ≥6 (95% CI: 19.8%–40.8%) (log-rank P = 0.020). There was a significant improvement in functional class and a reduction in hospitalizations for heart failure compared with the previous year (60.8% vs. 26.9%; P<0.001), along with a decrease in right heart failure signs (peripheral edema and ascites) and a significant improvement in hemodynamics.
Conclusion
In this high-risk population with severe TR, bicaval implantation using the TricValve device demonstrated significant clinical improvement at one-year follow-up, with mortality consistent with baseline risk as estimated by the TRI-SCORE.
Original Title: Bicaval TricValve Implantation in Patients With Severe Tricuspid Regurgitation. 1-Year Outcomes From the TricBicaval Registry.
Reference: Angel Sánchez-Recalde, et al. JACC Cardiovasc Interv. 2025;18:1913–1924.
Subscribe to our weekly newsletter
Get the latest scientific articles on interventional cardiology
 es una enfermedad cuya prevalencia se estima continuará en aumento en los próximos años.){kind=link}