Incidence, Predictors and Outcomes of Bleeding Following Transcatheter Tricuspid Valve Repair

BACKGROUND: Bleeding remains among the most common complications following catheter-based structural heart procedures. Its clinical implications following transcatheter tricuspid valve interventions have yet to be systematically evaluated. OBJECTIVES: The aim of this study was to evaluate the incidence of bleeding and its predictors and prognostic implications following transcatheter tricuspid valve repair. METHODS: TriValve (International Multisite Transcatheter Tricuspid Valve Therapies Registry; NCT03416166) is an international multicenter registry capturing a range of transcatheter tricuspid valve interventions. Bleeding events were classified according to the Bleeding Academic Research Consortium (BARC). For this analysis, BARC bleeding events type 2, 3, and 5 occurring within 1 year of transcatheter tricuspid valve repair were retrospectively evaluated. RESULTS: A total of 440 patients (mean age 76.6 ± 8.9 years, 57.7% women) were included. The BARC major bleeding incidence was 11.4% (50 patients). Postprocedural tricuspid regurgitation severity (adjusted ORl]: 1.83; 95% CI: 1.12-3.01; P = 0.02), higher systolic pulmonary artery pressures (adjusted OR: 1.61; 95% CI: 1.16-2.24; P = 0.0048), and increasing procedure duration (adjusted OR: 1.49; 95% CI: 1.00-2.22; P = 0.049) were associated with bleeding, whereas concomitant oral anticoagulation was not (adjusted OR: 1.51; 95% CI: 0.74-3.10; P = 0.30). Major bleeding was associated with a markedly increased risk for in-hospital death (adjusted OR: 106; 95% CI: 1.31-8,553; P = 0.04). Likewise, bleeding was significantly associated with a 1-year composite of death or all-cause hospital readmission (adjusted HR: 2.41; 95% CI: 1.39-4.19; P = 0.002), all-cause death (adjusted HR: 3.55; 95% CI: 1.75-7.21; P = 0.0004), and cardiovascular death (adjusted HR: 3.72; 95% CI: 1.62-8.52; P = 0.002). CONCLUSIONS: BARC major bleeding occurs in about 11% of patients following transcatheter tricuspid valve repair and is a major determinant of in-hospital and 1-year death. Enhanced patient selection and procedural optimization (with shorter procedural times) may help curb bleeding risk.