TRANSCATHETER tricuspid valve interventions (TTVI) for tricuspid regurgitation (TR) dramatically increased across Germany between 2018–2023, while tricuspid valve surgery (TVS) volumes remained largely unchanged, according to research presented at EuroPCR 2026.
The nationwide analysis also found that patients undergoing TTVI experienced lower in-hospital mortality and shorter hospital stays compared with isolated TVS.
Tricuspid Regurgitation Treatment Shifts Towards TTVI
TR, a condition in which the tricuspid valve does not close properly and allows blood to leak backwards within the heart, has historically been difficult to manage in older or frail patients who may not tolerate open-heart surgery. The development of minimally invasive transcatheter therapies has rapidly expanded treatment options in recent years.
Researchers from Deutsches Herzzentrum der Charité, Berlin, Germany, retrospectively analysed national German data from 2018–2023 using diagnosis-related group coding records.
The study included 10,301 patients treated with TTVI and 1,324 patients who underwent isolated TVS. Patients with congenital valve disease, infective endocarditis, tricuspid stenosis, or significant multivalvular disease were excluded.
TTVI Volumes Increased More Than Tenfold
The analysis showed a striking increase in TTVI procedures over the six-year period. Annual TTVI cases rose from 312 procedures in 2018 to 3,596 in 2023, whereas isolated TVS volumes remained relatively stable, increasing only slightly from 223 to 231 procedures.
Patients undergoing TTVI were significantly older than those treated surgically, with a median age of 81 years versus 71 years for TVS patients (p<0.001). Despite their older age, TTVI patients experienced markedly better in-hospital outcomes.
In-hospital mortality was 2% in the TTVI group compared with 12% following isolated TVS (p<0.001). TTVI patients also had substantially shorter hospital stays, with a median length of stay of 7 days versus 17 days after surgery (p<0.001).
More Patients Returned Home After TTVI
Discharge outcomes also favoured the transcatheter approach. Overall, 91% of TTVI patients were discharged directly home compared with only 36% of surgical patients. Meanwhile, transfer to rehabilitation facilities or nursing care was considerably more common after surgery.
To reduce baseline differences between groups, investigators performed propensity score matching involving 1,200 patients in each cohort. Even after matching for age, sex, cardiovascular comorbidities, pulmonary hypertension, chronic kidney disease, diabetes, and prior cardiac surgery, outcomes remained strongly in favour of TTVI.
Matched analyses showed in-hospital mortality of 1% following TTVI compared with 10% after isolated TVS (p<0.001). Median hospital stay also remained significantly shorter at 8 days versus 16 days, respectively.
Implications for Future Tricuspid Regurgitation Care
The findings highlight how rapidly TTVI has been adopted in Germany as less invasive tricuspid valve technologies become more widely available. The researchers concluded that TTVI was associated with lower in-hospital mortality, shorter hospitalisation, and more frequent discharge home compared with isolated surgical treatment.
However, the analysis was retrospective and limited to in-hospital outcomes, meaning longer-term comparative data are still needed. Future studies will likely need to evaluate durability, long-term survival, and patient quality of life following transcatheter treatment for TR.
Reference
Mattig I et al. National trends in the treatment of tricuspid regurgitation in Germany from 2018 to 2023. Abstract A102206IM. EuroPCR 2026, 19-22 May, 2026.
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