Optimizing patient selection and procedural strategies can significantly improve outcomes in transcatheter tricuspid valve annuloplasty (TTVA), according to new research published in JACC: Cardiovascular Interventions. The study tracked 100 consecutive TTVA procedures between 2019 and 2023 and noted a shift in patient profiles from predominantly ventricular tricuspid regurgitation (TR) to more atrial TR. According to the research team, this reflected a more strategic case selection and corresponded with a jump in procedural success to 84% as well as a reduction in the median procedure time from 211 to 160 minutes. More findings “More liberal right coronary artery crossing to the atrial side... is probably also a reason for the shorter procedural times,” said the authors, led by Muhammed Gerçek, MD, from the Clinic for General and Interventional Cardiology/Angiology in Bad Oeynhausen, Germany. The study also found that among patients with large coaptation gaps (≥9 mm), 78% achieved moderate or less TR at discharge. For smaller gaps, that rate rose to 83%. Even for patients initially deemed unsuitable for TEER, a staged approach combining TTVA followed by TEER reduced TR to moderate or less in 67% of cases. “TTVA addresses the pathophysiology of TR more physiologically, preserving future therapeutic options,” the researchers concluded. A safe, effective option In their closing arguments, they advocated for renewed recognition of TTVA’s potential, calling it a safe, effective option, particularly when combined with other interventions in complex cases. TTVA is a promising but underutilized approach for treating TR. Initially, it was considered a last resort for complex cases, where other therapies like transcatheter edge-to-edge repair (TEER) were not feasible. As a result, early TTVA attempts frequently targeted patients with severe valve deformities or pacemaker-related complications — cases unlikely to respond well to stand-alone annuloplasty. Methodology The single center study analyzed 100 transcatheter tricuspid annuloplasty (TTVA) procedures performed between 2019–2023. The team evaluated the outcomes across four patient quartiles to assess how changes in patient selection and procedural techniques impacted efficacy, safety and tricuspid regurgitation severity. The median age of these patients was 79 years (Q1-Q3: 72-89 years), with 73% women. Sources: Kirchner J, Gerçek M, Ivannikova M, et al. High Procedural Efficacy With Transcatheter Tricuspid Annuloplasty by Optimizing Patient Selection and Procedural Approach. JACC Cardiovasc. Interv. 2025. (Article in Press). Image Credit: M+Isolation+Photo – stock.adobe.com