Outcomes of Transcatheter Tricuspid Edge-to-Edge Repair and Transcatheter Valve Replacement for Severe Tricuspid Regurgitation: A Systematic Review and Meta-Analysis

Abstract Background Severe tricuspid regurgitation (TR) is associated with substantial morbidity, mortality, and impaired quality of life. Transcatheter tricuspid edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as treatment options, but comparative evidence to guide procedural selection remains limited. Aims To systematically evaluate the safety and clinical outcomes of T-TEER and TTVR in patients with severe TR. Methods and results A systematic review and meta-analysis were performed according to PRISMA guidelines, including studies published through July 2025. Random-effects models were used to pool outcomes at in-hospital, 30-day, and 1-year follow-up. Twenty studies comprising 4,468 patients undergoing T-TEER and 20 studies including 1,017 patients undergoing TTVR were included. T-TEER was associated with very low in-hospital (0.13%) and 30-day (0.46%) mortality, with 1-year mortality of 10.16%. Early mortality was high following TTVR, whereas 1-year mortality was similar between strategies. TTVR achieved more complete and durable elimination of severe TR, while T-TEER resulted in meaningful but less complete TR reduction. Both approaches were associated with substantial improvements in New York Heart Association functional class and quality of life. TTVR was associated with higher rates of permanent pacemaker implantation, thrombotic events, and major bleeding that increased over time, whereas bleeding after T-TEER was predominantly peri-procedural. Changes in right ventricular systolic function were modest and similar between approaches. Conclusion T-TEER and TTVR are associated with improvements in clinical and echocardiographic outcomes in patients with severe tricuspid regurgitation. These findings are descriptive and hypothesis-generating, highlighting the need for prospective studies to clarify optimal patient selection and long-term outcomes.