Reviwer : Dr. Cem Çöteli

Name of the Study :
TRISCEND: Transfemoral Tricuspid Valve Replacement In Patients With Tricuspid Regurgitation

Published in Congress : ACC 2021

Link : not published yet

Background :
Even the recent guidelines suggest surgery for severe tricuspid valve regurgitation, an important number of the patients with severe tricuspid valve regurgitation are not candidates for surgery because of many comorbidities or previous heart surgery history. Consequently, percutaneous tricuspid valve interventions are under investigation, and the EVOQUE system is one of them.

Objective :
The main objective of the TRISCEND trial is evaluating the feasibility of transfemoral tricuspid valve replacement, which is the EVOQUE system from Edwards.

Method :
The TRISCEND trial is a prospective, single-arm, multicenter study.  The study population was the patients who are symptomatic and with moderate or greater TR. 90% of the patients had severe TR and 44% of the patients had massive TR. The patients were enrolled after evaluation with TEE and CTA if they were anatomically suitable. The outcomes of the study were procedural success, which means procedure without a severe paravalvular leak, and major adverse events at 30 days.

Results :
The median age of the study population was 79 years. The patients had a high risk for surgery and lots of comorbidities, such as atrial fibrillation, ascites, previous valve history. The total number of patients was 56 and the valve was deployed successfully in all but one patient. The length of hospital stay was 3 days. 89% of the patients were discharged to home. Twelve patients (22.6%) faced MACE at 30 days. Cardiovascular mortality and all-cause mortality were observed in 1 patient and 2 patients, respectively. In 12 patients (22.6%), severe bleeding was observed but none of them was fatal bleeding according to the BARC bleeding definition. In 98% of patients, the reduction in TR severity to none/mild at 30 days was achieved. Grade one or more, and grade two or more reduction at 30 days were achieved in 100% and 95% of patients, respectively.

Conclusion :
Transcatheter tricuspid valve replacement is a feasible and effective method of reducing TR.

Comment :
Patients who have left ventricular heart diseases, such as left heart failure or severe mitral valve regurgitation, could be symptomatic because of severe tricuspid valve regurgitation. Severe TR is especially an important problem when the patients are at the late stages of left heart disease. So, most of these patients lose the surgery option when they are symptomatic. Transcatheter tricuspid valve interventions could be a hope for these patients. However, there isn’t enough evidence to define them as a therapy of the future. Even with the high procedural success in the TRISCEND trial, I think we still need more large-scale trials and longer follow-up durations to encourage patients and physicians for transcatheter tricuspid valve interventions.