Cumitini L; Maggiore della Carita Hospital, Novara, Italy.
Giubertoni A; Mennuni M; Degiovanni A; Patti G

American Journal of Cardiology. 272:54-59, 2026 Aug 01.

Transcatheter tricuspid valve interventions have recently emerged as
effective therapeutic options for patients with severe tricuspid
regurgitation (TR) and heart failure at high surgical risk. Despite
evidence of post-procedural clinical improvement, data regarding changes
in functional capacity remain limited. In this prospective, observational
study, we enrolled high-risk patients with at least severe TR and heart
failure undergoing transcatheter tricuspid valve repair by the PASCAL
device or replacement with the EVOQUE system. Functional capacity was
evaluated by cardiopulmonary exercise testing (CPET), in addition to
clinical, laboratory, and echocardiographic parameters, at baseline and 3
months postprocedure. The primary endpoint was the change in peak oxygen
consumption (VO2) by CPET at 3 months versus baseline. Secondary endpoints
included changes in other CPET parameters, TR severity by transthoracic
echocardiography, New York Heart Association (NYHA) class, daily
furosemide dose, and pro-brain natriuretic peptide (pro-BNP) levels. A
total of 10 patients were enrolled, with successful device implantation
obtained in all cases. Peak VO2 improved significantly from 14.7 +/- 3.7
at baseline to 16.4 +/- 2.9 ml/kg/min at 3 months (p = 0.009). Peak oxygen
pulse increased from 85.1 +/- 20.2% to 103.7 +/- 23.3% (p = 0.022), and
ventilation maximum rose from 39.9 +/- 10.3 L/min to 45.7 +/- 10.9 L/min
(p = 0.035). TR severity was reduced (p = 0.002), NYHA class improved (p =
0.016), and daily furosemide dose decreased (p = 0.016). Although pro-BNP
levels declined, this reduction was not statistically significant. No
adverse event occurred during follow-up. In conclusion, among patients
with severe TR and heart failure, TR reduction by transcatheter tricuspid
valve interventions was associated with improved CPET-derived functional
capacity, better functional class, and reduced diuretic requirement during
short-term follow-up.