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 a widely available treatment option for patients with tricuspid regurgitation (TR). However, not all patients benefit from T-TEER and may require alternative transcatheter tricuspid valve interventions (TTVI). The aim of the study was to characterize patients with severe TR referred for transcatheter treatment and identify potential candidates for alternative TTVI. Methods The CAPTURE Pilot Study (NCT 06838611) enrolls consecutive patients referred for TR treatment. All patients undergo clinical and echocardiographic assessment to determine eligibility for T-TEER. Those deemed anatomically ineligible or with unsuccessful T-TEER are considered for alternative TTVI. 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%; < 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 study, approximately half of patients with severe TR were eligible for T-TEER, while more than 20% may require alternative TTVI. This subgroup exhibits more advanced disease and a higher prevalence of bleeding risk factors, which should be carefully considered during the decision process.