Impact of Fluid Overload on Outcomes After Transcatheter Tricuspid Valve Repair (FLOOD-TTVr)

BACKGROUND: Transcatheter tricuspid valve repair (TTVr) has emerged as an effective treatment strategy for patients with tricuspid regurgitation (TR). Fluid overload (FO) is a key symptom of TR. Although current clinical consensus recommends preprocedural decongestive therapy, the impact of FO on feasibility of TTVr has not yet been systematically investigated. METHODS: Consecutive patients with severe TR undergoing TTVr between November 2021 and February 2023 at the Heart Center of the University Hospital Cologne were prospectively enrolled. FO was quantified by bioimpedance spectroscopy (BIS). Procedural and clinical outcomes according to TVARC were compared between patients with and without FO, defined as FO ≥1.0 L by BIS. RESULTS: Among the 52 patients included in this study, 21 (40%) displayed FO. TTVr resulted in significant reductions in TR grade with low periprocedural complication rates and low 1-year mortality in patients with and without FO. Both groups demonstrated significant reverse RV remodeling, improvements in NYHA class and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score at 30 days, and reductions in annual heart failure hospitalizations. However, FO was associated with higher periprocedural bleeding rates and lower clinical success at 30 days and 1 year. CONCLUSIONS: A substantial proportion of patients undergoing TTVr displayed persistent FO, which was associated with reduced procedural safety and efficacy. Particularly, 30-day and 1-year clinical success was significantly lower in patients with FO than in those without FO. Collectively, our data therefore encourage future studies evaluating the prognostic impact of persistent FO on long-term TTVr outcomes.