Transcatheter therapies for tricuspid regurgitation: A meta-analysis of randomized trials

Severe tricuspid regurgitation (TR) is prevalent in elderly patients and associated with poor prognosis. Transcatheter tricuspid valve interventions (TTVI) have emerged as a therapeutic option for patients at high surgical risk. However, the clinical benefit of TTVI compared with optimal medical therapy (OMT) remains uncertain.

To assess the impact of TTVI versus OMT alone on clinical outcomes in patients with severe symptomatic TR.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TTVI (either transcatheter edge-to-edge repair [TEER] or replacement [TTVR]) with OMT in patients with severe symptomatic TR. MEDLINE was searched for RCTs published from January 2010 to December 2024. Outcomes of interest at one year included all-cause mortality, cardiovascular mortality, hospitalization for heart failure (HFH), and tricuspid valve re-intervention. A random-effects model was used to estimate odds ratios (ORs). Individual patient data were reconstructed from Kaplan-Meier curves where necessary.

Three RCTs (1050 patients) were included. No significant differences were observed in all-cause mortality (OR 1.01; 95 % CI: 0.63-1.60), cardiovascular death (OR 1.04; 95 % CI: 0.61-1.77), or HFH (OR 0.87; 95 % CI: 0.61-1.25). Tricuspid re-intervention rates were numerically lower with TTVI (OR 0.43; 95 % CI: 0.14-1.29).

In this meta-analysis of RCTs, TTVI did not significantly reduce hard clinical endpoints at one year compared with OMT alone. Further studies with longer follow-up are needed.