ObjectivesOur objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI).MethodsThis prospective, multicenter, non-randomized controlled pilot study enrolled patients (N=40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n=20) or torasemide monotherapy (n=20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events.ResultsTAPSE significantly increased in the tolvaptan group compared with the control group after 10days of medication (P=0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (timexgroup, P=0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group.ConclusionsOur results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement.Clinical Trial RegistrationClinicalTrials.gov identifier no. NCT02644616.