Objective Assessment of Functional Capacity Improvement Following Transcatheter Tricuspid Valve Interventions

: 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 post-procedure. 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.