Screening and Qualification for Transcatheter Tricuspid Valve Interventions – Preliminary Findings from the CAPTURE Pilot Study

Background: Transcatheter tricuspid edge-to-edge repair (T-TEER) is the most widely used treatment option for patients with tricuspid regurgitation (TR). In real-world practice, a substantial proportion of referred patients are not eligible for T-TEER or do not achieve an adequate early TR reduction and may therefore require alternative transcatheter tricuspid valve interventions (TTVI) – orthotopic or heterotopic tricuspid valve implantation. The aim of the study was to characterize patients with severe TR referred for transcatheter treatment, and identify patients in whom alternative TTVI may be required. Methods The CAPTURE Study (NCT 06838611) enrolls consecutive patients referred for TR treatment. All patients undergo clinical and echocardiographic assessment to determine eligibility for T-TEER. Candidates for TTVI other than T-TEER were defined as patients disqualified from T-TEER due to anatomical ineligibility or those with unsuccessful T-TEER, defined as next-day TTE showing TR more than moderate. This pilot analysis includes patients enrolled from November 2023 to December 2024. Results 147 patients were enrolled, 77 (52.4%) patients were qualified for T-TEER and the procedure was performed in 71 (48.3%) patients, with successful TR reduction in 55 cases (77.5% of treated patients); a subset of 34 patients (23.1%) was identified as potential candidates for alternative TTVIs. These patients exhibited more advanced TR (torrential TR 76.5% vs. 18.2%; p<0.001) and right heart failure symptoms (ascites 44.1% vs. 12.7%; p<0.001). Additionally, they had significantly higher bilirubin concentration (1.09 [1.20] mg/dl vs. 0.61 [0.42] mg/dl; p=0.003), lower hemoglobin level (11.8 [1.7] g/dL vs. 12.3 [1.7] g/dL; p=0.017) and platelet count (161.0 [51.0] x 109/L vs. 183.0 [79.0] x 109/L; p=0.015) suggesting an increased bleeding risk. Conclusions In this preliminary single-center real-world cohort, approximately half of patients with severe TR were eligible for T-TEER, whereas more than 20% emerged as potential candidates for alternative TTVI strategies. This subgroup was characterized by more advanced right-sided remodeling and laboratory features suggestive of hepatic dysfunction and increased bleeding risk, which may have important implications for Heart Team decision-making and procedural planning.