August 16, 2025

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

Key Points

T-TEER significantly reduces heart failure hospitalizations compared to optimized medical therapy alone.
Among 1805 patients analyzed, T-TEER showed a significant improvement in functional status and quality of life scores.
The assessment used a random-effects model with outcomes measured by risk ratios and confidence intervals.
Despite improvements in clinical symptoms, T-TEER showed no significant effect on all-cause mortality or cardiovascular death.

Abstract

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. 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. 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). 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.

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