Tricuspid transcatheter edge-to-edge repair for severe symptomatic tricuspid regurgitation: a systematic review and meta-analysis

Background: Severe tricuspid regurgitation is associated with elevated morbidity and mortality. In recent years, tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as a promising procedure for the treatment of this valvular disease. We conducted a systematic review and meta-analysis to compare the effectiveness of T-TEER with optimized medical therapy (OMT) versus OMT alone for the treatment of severe tricuspid regurgitation. Methods: PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) and observational studies comparing T-TEER plus OMT vs. OMT alone. Heterogeneity was assessed with I2 statistics, and a random-effects model was used for all the outcomes. Results: We included two RCTs and four observational studies with a total of 1805 patients, of whom 849 (47%) underwent T-TEER plus OMT. We found a trend favoring T-TEER for all-cause mortality [risk ratio 0.87; 95% confidence interval (95% CI) 0.66-1.13; P = 0.30] and cardiovascular death (risk ratio 0.77; 95% CI 0.36-1.65; P = 0.50), although without statistically significant difference. Heart failure hospitalizations (risk ratio 0.72; 95% CI 0.61-0.85; P = 0.0001) were significantly reduced in patients treated with T-TEER compared with OMT alone. Tricuspid regurgitation severity 2+ or less was also more frequently achieved in the T-TEER group (risk ratio 6.42; 95% CI 3.08-13.39; P < 0.001). Functional status and quality of life were significantly improved, with higher KCCQ scores [(mean difference) +14.01], longer 6MWT distance (MD +29.35 m), and a greater proportion of patients in NYHA class I-II (risk ratio 1.39; 95% CI 1.27-1.51; P < 0.00001). Conclusion: In patients with severe symptomatic TR, T-TEER is associated with significant improvements in tricuspid regurgitation severity, reduction in heart failure hospitalizations, and enhanced quality of life and functional status, with no apparent effect on all-cause mortality and cardiovascular death.