Sex-Related Characteristics and Short-Term Outcomes of Patients Undergoing Transcatheter Tricuspid Valve Intervention for Tricuspid Regurgitation

Background and aims: The impact of sex in patients with significant tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI) is unknown. The aim of this study was to investigate sex-specific outcomes in patients with significant TR treated with TTVI versus medical therapy alone. Methods: The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected patients with significant TR from 24 centers who underwent TTVI from 2016 to 2021. A control cohort was formed by medically managed patients with ≥ severe isolated TR diagnosed in 2015-2018. Primary endpoint was freedom from all-cause mortality. Secondary endpoints were heart failure (HF) hospitalization, New York Heart Association (NYHA) functional status, and TR severity. One-year outcomes were assessed for the TriValve cohort and compared with the control cohort with the inverse probability of treatment weighting (IPTW). Results: A total of 556 and 2072 patients were included from the TriValve and control groups, respectively. After TTVI, there was no difference between women and men in 1-year freedom from all-cause mortality (80.9% vs. 77.9%, p = 0.56, nor in HF hospitalization (p = 0.36), NYHA functional class III-IV (p = 0.17), and TR severity >2 + at last follow-up (p = 0.42). Multivariable Cox-regression weighted by IPTW showed an improved 1-year survival after TTVI compared to medical therapy alone in both women (adjusted hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.23-0.83, p = 0.01) and men (adjusted HR 0.42, 95% CI 0.18-0.89, p = 0.03). Conclusions: After TTVI in high-risk patients, there were no sex-related differences in terms of survival, HF hospitalization, functional status, and TR reduction up to 1 year. The IPTW analysis shows a survival benefit of TTVI over medical therapy alone in both women and men.