A new era for tricuspid valve disease?

The TRIC-I-HF trial has delivered what many interventional cardiologists have been waiting for: the first randomized evidence that transcatheter tricuspid valve repair (TTVR) can meaningfully reduce death and heart failure (HF) hospitalizations. Presented at the ESC Congress 2026 and simultaneously published in the New England Journal of Medicine, the trial enrolled 360 high-risk patients (mean age 80, 56% women) with severe tricuspid regurgitation across 29 German centers.

Compared to medical therapy alone, TTVR plus medical therapy produced a win ratio of 2.42 for the hierarchical composite of all-cause death, HF hospitalization, and quality-of-life improvement. The survival and hospitalization curves continued to diverge over three years, reinforcing the durability of the benefit. Experts likened the results to the landmark COAPT trial, which transformed transcatheter mitral valve repair.

By the Numbers

• 60% relative reduction in the combined endpoint of mortality and HF hospitalization
• NNT of 4 to prevent one death or HF hospitalization at 1 year
• 52.4% vs. 21.0% — freedom from death or HF hospitalization at 3 years (TTVR vs. medical therapy)
• 80% vs. 51.3% — alive and free from HF hospitalization at 1 year
• 72.3% vs. 53.9% — survival rates at 3 years (TTVR vs. medical therapy)

Why it matters

Prior tricuspid trials (Tri.Fr, TRILUMINATE Pivotal) only showed quality-of-life gains — never hard clinical endpoints. TRIC-I-HF changes that calculus entirely, potentially reshaping guidelines and expanding access to TTVR for the growing population of patients with severe, symptomatic tricuspid regurgitation.