ESC Congress 2026 Abstract · Oct 26, 2026

Transcatheter tricuspid valve repair: long-term survival and economic implications in a German real-world cohort

By Piayda K, Jobst J, Unsoeld B et al.

Background and aims: Transcatheter tricuspid valve repair (T-TEER) is increasingly used in patients deemed unfit for surgery. Large-scale real-world data on long-term survival predictors and health economic implications within the German health system are limited. We sought to identify mortality predictors—frailty and comorbidity burden—and to assess costs before and after T-TEER using a national health-insurance database. Purpose: To evaluate long-term survival determinants (age, frailty, and comorbidities) and to quantify one-year post-procedural cost changes in a large German real-world T-TEER cohort. Methods: Observational analysis of all T-TEER patients (01/2018–12/2023) in the BARMER database (~10% of the German population). Frailty was assessed via care levels (“Pflegegrad”). Cox proportional hazards models quantified associations with survival. Costs were compared 12 months before vs. after T-TEER. Results: Among 1,712 patients, age groups (50–69, 70–79, 80–99) showed no significant survival differences; female sex was protective (HR 0.51). Frailty strongly predicted mortality: care levels 3–5 vs 0–2 had HR 2.30 (p<0.001). Non-cardiac comorbidities increased mortality risk: ≥3 comorbidities HR 1.85 (p<0.001). Right-heart failure was the primary cardiac predictor for increased mortality after T-TEER (HR 1.96, p<0.001). One-year costs decreased substantially after T-TEER: median costs fell from €14,843 to €11,573 (p<0.00001). Interestingly, even among patients with a high burden of cardiac and non-cardiac comorbidities—such as baseline right heart failure and chronic kidney disease—the center’s volume did not demonstrate a volume–outcome relationship. Conclusion: In this real-world German cohort, frailty and non-cardiac comorbidity burden, rather than age, were the dominant predictors of long-term mortality after T-TEER. The procedure was associated with a meaningful reduction in subsequent medical costs at one year. These findings support prioritizing frailty and multimorbidity assessment in patient selection and health-economic planning for T-TEER.

doi.org/10.1093/eurheartj/ehag785.2914 Open access Interventions