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Tricuspid-Valve Intervention in Heart Failure
Key result
Transcatheter tricuspid repair cuts death or HF hospitalization ~60% versus medical therapy.
- Win Ratio 2.42
- 95% CI 1.76-3.33
- P<0.001
- n=360
Why the trial?
Significant tricuspid regurgitation is common in heart failure and carries a poor prognosis, but whether intervening on the valve improves outcomes beyond medical therapy remains uncertain. TRIC-I-HF tested tricuspid valve intervention in this population.
Does transcatheter tricuspid-valve repair plus medical therapy improve a composite of death, heart failure hospitalization, and quality of life in patients with symptomatic severe tricuspid regurgitation?
Population
360 patients, severe symptomatic TR + high HF-event risk (age 80.3; 56.4% women)
Comparison
Transcatheter tricuspid-valve repair + medical therapy vs medical therapy alone
Design
Randomized (2:1) trial; hierarchical win-ratio first primary endpoint
Follow-up
1 year (first primary); through 3 years (second primary)
Authors
Discussion
1 takeMember takes
Key expert perspectives
Captured external expert commentary on this trial, strongest first. Original sources are linked where available.
TRIC-I-HF is an investigator-initiated, randomized controlled trial that demonstrated transcatheter tricuspid-valve repair plus optimal medical therapy significantly improved a hierarchical composite of death, heart failure hospitalization, and quality of life at 1 year (win ratio 2.42; p<0.001) and reduced death or hospitalization through 3 years (HR 0.40; p<0.001) in heart failure patients with severe tricuspid regurgitation. The trial was presented as a Hot Line at ESC Congress 2026 by Jörg Hausleiter, with key subgroup results also presented at TCT 2026.
1 take classified by contention axis so far — the map appears as more land.
“Randomized controlled trials are the cornerstone of evidence-based cardiovascular medicine because they provide the highest level of evidence to guide clinical practice. This year, ESC Congress received a record number of submissions of late-breaking clinical trials, reflecting the remarkable pace of innovation across cardiology. We rigorously selected the studies with the greatest scientific quality and potential clinical impact.”
“@MAnisHaider @jtsaxon One important correction. Baseline TR severity was greater in TRILUMINATE than in TRICI-HF… by a good amount.”
TATranscatheter Academy
“#ESCCongress2026 | Impact Meter Highlights Could TRIC-I-HF change the treatment landscape for patients with tricuspid regurgitation and heart failure? Prof Nicole Karam discusses the standout valvular heart disease data from ESC 2026, including key TAVI studies and their”
Implication
Supports transcatheter tricuspid repair plus medical therapy in symptomatic severe tricuspid regurgitation; delivers first randomized evidence of hard-endpoint benefit.
Key Points
- To evaluate the efficacy and safety of transcatheter tricuspid-valve repair added to medical therapy versus medical therapy alone in patients with symptomatic severe tricuspid regurgitation at high risk for heart failure events.
- Randomized, controlled trial assigning 360 patients in a 2:1 ratio to transcatheter tricuspid-valve repair plus medical therapy (N=237) or medical therapy alone (N=123; NCT04634266).
- Evaluated a first primary hierarchical composite endpoint (all-cause death, heart-failure hospitalization, and quality-of-life improvement at 1 year via win ratio) and a second primary endpoint of all-cause death or heart-failure hospitalization through 3 years.
- Tricuspid-valve repair significantly improved the 1-year hierarchical primary composite outcome compared with medical therapy alone (win ratio, 2.42; 95% CI, 1.76 to 3.33; P<0.001).
- Through 3 years, freedom from all-cause death or heart failure hospitalization was 52.4% (95% CI, 43.2 to 63.6) with repair versus 21.0% (95% CI, 12.7 to 34.6) with medical therapy alone (HR, 0.40; 95% CI, 0.29 to 0.55; P<0.001).
- Major adverse events occurred in 14 patients (5.9%) within 30 days of the tricuspid-valve repair procedure.
Evidence details
What drove the result?
| Outcome | TV repair | Medical |
|---|---|---|
| Death, HF hospitalization, QoL improvement (hierarchical, 1 yr) | ||
| First primary · win ratio 2.42 (95% CI 1.76–3.33; p<0.001) favoring repair; per-arm values not reported | ||
| Freedom from death or HF hospitalization through 3 years | 52.4% | 21.0% |
| Second primary · HR 0.40 (95% CI 0.29–0.55; p<0.001) for death or HF hospitalization | ||
Limitations & tradeoffs
Safety
Major adverse events within 30 days occurred in 14/237 (5.9%) in the repair arm.
Statistical certainty
2:1 randomization left a modest medical-therapy arm of 123 patients, and 3-year Kaplan–Meier estimates carry wide confidence intervals (52.4% [43.2–63.6] vs 21.0% [12.7–34.6]).
Design limitations
The first primary endpoint includes patient-reported quality of life, and blinding is not described in the record.
Structured PICO
Does transcatheter tricuspid-valve repair plus medical therapy improve a composite of death, heart failure hospitalization, and quality of life in patients with symptomatic severe tricuspid regurgitation?
P
Population
360 patients (mean age 80.3 years, 56.4% women) with symptomatic severe tricuspid regurgitation and increased risk of future heart-failure events, followed for up to 3 years.
I
Intervention
Transcatheter tricuspid-valve repair plus medical therapy
C
Comparator
Medical therapy alone
O
Outcome
First primary end point: hierarchical composite of death from any cause, hospitalization for heart failure, and quality-of-life improvement at 1 year. Second primary end point: composite of death from any cause or hospitalization for heart failure through 3 years.composite
Main Result
Effect estimate: Win Ratio 2.42 (95% CI 1.76-3.33)
p-value: p=<0.001
Transcatheter tricuspid-valve repair added to medical therapy significantly improves a hierarchical composite of death, heart failure hospitalization, and quality of life at 1 year, and reduces death or heart failure hospitalization through 3 years in patients with severe tricuspid regurgitation.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Hausleiter et al. (2026) conducted an RCT in symptomatic severe tricuspid regurgitation (n=360). transcatheter tricuspid-valve repair plus medical therapy vs. medical therapy alone was evaluated on hierarchical composite of death from any cause, hospitalization for heart failure, and quality-of-life improvement at 1 year (Win Ratio 2.42, 95% CI 1.76-3.33, p=<0.001). Transcatheter tricuspid-valve repair was superior to medical therapy for a composite of death, heart failure hospitalization, and quality of life (Win Ratio 2.42; 95% CI 1.76-3.33; P<0.001).