Tricuspid transcatheter edge to edge repair vs surgery for tricuspid regurgitation - a systematic review and meta - analysis

Abstract Introduction Surgical tricuspid valve repair/replacement (TVR) is considered the gold standard method for treating severe primary tricuspid regurgitation (TR) and asymptomatic patients with progressive right ventricular (RV) dilatation or RV dysfunction. However, transcatheter tricuspid valve repair (TTVR) has emerged as a promising alternative to surgical intervention, because it offers several potential advantages, including avoiding open-heart surgery, shorter hospital stays, and reduced post-procedural recovery time. The most commonly used TTVR technique is tricuspid transcatheter edge to edge repair (T-TEER). Purpose To perform a systematic review and meta-analysis to compare the safety, early and late mortality, morbidity and long-term function of the tricuspid valve (TV) following T-TEER compared to TVR for either primary or organic TR (oTR) or secondary or functional TR (fTR). Methods This review investigates through PubMed and the Cochrane Library databases for randomized control trials (RCTs) or observational studies that evaluated patients with TR who underwent either T-TEER or TVR was until December 2024. The outcomes of interest were safety, morbidity, mortality and long-term function following T-TEER vs TVR. A Mantel–Haenszel random-effects model was used to calculate pooled odds ratios (ORs) for this meta-analysis and ORs with 95% CIs were calculated to assess outcome differences after T-TEER or TVR, using RevMan 5.4. Results We identified three retrospective observational studies, including a total of 1612 patients with TR. Short-term mortality (OR, 0.36; 95% CI, 0.13–1.04; P=0.06) was similar between T-TEER and TVR. There was a lower risk of acute kidney injury (AKI) (OR, 0.31; 95% CI, 0.23-0.43; P 0.00001) and permanent pacemaker implantation (PPI) (OR, 0.19; 95% CI, 0.10-0.35; P 0.00001) with T-TEER, while there was no significant difference in terms of stroke events (OR, 1.17; 95% CI, 0.68–2.01; P=0.58) and incidence of bleeding complications (OR, 0.81; 95% CI, 0.45–1.44; P=0.47) compared to TVR. Conclusions In conclusion, T-TEER offers a promising, safe and less-invasive alternative for managing patients with TR. Although, T-TEER has a similar safety profile to TVR with a lower risk of AKI and PPI, future research is needed to confirm its efficacy and safety. Integration of T-TEER into routine practices, and future guidelines, could optimize management of TR and offer a less invasive alternative for high-risk patients.