• caval valve implantation
• cavi
• t-teer
• teer
• transcatheter edge-to-edge repair
• transcatheter tricuspid valve intervention
• tricuspid regurgitation
• tricuspid valve
• ttvi

Background: Severe tricuspid regurgitation (TR) is a debilitating condition associated with significant morbidity and poor quality of life. Reducing TR can alleviate symptoms and improve clinical outcomes of affected patients.
Methods: This study aims to assess the efficacy and safety of transcatheter tricuspid valve intervention (TTVI) in patients with severe symptomatic TR, particularly focusing on tricuspid transcatheter edge-to-edge repair (T-TEER) and caval valve implantation (CAVI). Participants were enrolled in Azienda Ospedaliero Universitaria Pisana. All patients underwent a preliminary clinical and echocardiographic assessment in order to identify anatomical feasibility of TTVI. The TRI-SCORE, a validated tool used to predict mortality risk following tricuspid valve surgery, was calculated. Patients suitable for TTVI subsequently underwent transcatheter interventions, with T-TEER as first choice treatment. All patients were followed-up at 1, 6, and 12 months after the procedure. The primary endpoint was a composite of death from any cause and hospitalization for heart failure during follow-up. Secondary endpoints included the severity of TR and NYHA functional class at follow-up.
Results: A total of 23 patients were enrolled, with a mean age of 80 years; 56.5% of the participants were women. The T-TEER group showed a significant improvement of TR at follow-up, with a residual TR grade ≤ 2+ in 94% of cases (p = 0.0001). At 30 days, 87% of the TTVI population was in NYHA functional class I/II, compared to 8.7% pre-procedure. TTVI was safe, with no complications reported within the 30 days following the intervention. Three predictors of the composite endpoint were identified: history of hospitalization for heart failure before TTVI, a TRI-SCORE > 5, and haemoglobin levels ≤ 10 g/dl.
Conclusions: T-TEER and CAVI are safe interventions for patients with severe TR, significantly improving quality of life and reducing TR severity. T-TEER, in particular, demonstrated remarkable efficacy in reducing TR. Our findings suggest the possibility to discriminate between “Late-Stage TR” and “Non-Late-Stage TR” based on the three composite endpoint predictors. This classification might be useful to identify which patients are more likely to benefit from TTVI.