Cost-Effectiveness of Early TAVR; TR and Mortality; Superiority of Tricuspid Repair

New late-breaking research presented at TCT 2026 highlights the cost-effectiveness of early TAVR in asymptomatic severe aortic stenosis (AS), the association between increasing tricuspid regurgitation (TR) severity and mortality, and the benefits of transcatheter tricuspid valve repair.

Cost-Effectiveness of Early TAVR In patients with asymptomatic severe AS, the costs of preemptive TAVR and clinical surveillance over a five-year period were similar, despite higher up-front costs with preemptive TAVR, according to findings from the EARLY TAVR trial . Neel Butala, MD, MBA, FACC , et al., randomized 901 patients (age ≥65 years) with asymptomatic severe AS to TAVR or clinical surveillance.

At five years, the mean cumulative costs of TAVR were $68,572 compared to $85,044 for clinical surveillance. The difference of $1,528 was not statistically significant (p=0.60). Butala notes that "early TAVR led to a small gain in quality-adjusted life years, driven by short-term symptom avoidance, reduced risk of stroke and a trend toward improved survival." Investigators project that early TAVR would lead to an increase in lifetime costs of approximately $4,500 and a gain of 0.3 quality-adjusted life years – an incremental cost-effectiveness ratio of $14,698 per quality-adjusted life year gained.

As a result, they consider early TAVR to be "highly cost-effective" when compared to clinical surveillance. TR and Mortality Additional late-breaking science explores trends in TR severity and the superiority of transcatheter tricuspid valve repair (TTVr) in treating patients with severe TR.

In an analysis of 180,977 patients with TR from the National Echocardiographic Database of Australia, Rebecca T. Hahn, MD, FACC, et al., sought to evaluate the prevalence, characteristics and prognostic impact of differing TR severities. Of note, mortality risk progressively increased with more severe TR grades.

When compared to mild TR, the adjusted hazard ratio for all-cause mortality ranged from 1.257 for moderate TR up to 2.129 for torrential TR. When investigating differences by sex, women exhibited lower all-cause mortality and but higher premature mortality, resulting in similar life years lost.

Superiority of Tricuspid Repair In the TRIC-I-HF-DZHK24 trial , Jörg Hausleiter, MD, et al., found that TTVr with optimal medical therapy was superior to optimal medical therapy alone in patients with severe symptomatic TR at increased risk of future heart failure (HF) events. Including 29,151 patient pairs, their win ratio analysis found that tricuspid repair reduced mortality and HF hospitalization while improving KCCQ (win ratio: 2.24 [95% CI: 1.76-3.33); p<0.0001).

Hausleiter and colleagues add that the superiority of tricuspid repair was seen in patients both with and without previous HF hospitalization, with and without secondary organ dysfunction and in patients with severe and massive TR. Results for torrential TR were inconclusive due to small sample size.

TCT 2026 Meeting Coverage Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound Keywords: Transcatheter Cardiovascular Therapeutics, TCT26, Transcatheter Aortic Valve Replacement, Tricuspid Valve, Tricuspid Valve Insufficiency, Echocardiography, Aortic Valve Stenosis, Heart Failure, Stroke