Impact of Transcatheter Mitral and Tricuspid Valve Repair on Hepatic Function and Outcomes in Patients with Cirrhosis or Advanced Liver Disease—A Personalized Approach

Background: Transcatheter edge-to-edge repair (TEER) has emerged as an established treatment option for patients with severe mitral (MR) and tricuspid regurgitation (TR) who are at high surgical risk. Patients referred for TEER frequently present with advanced comorbidities, including cirrhosis or chronic liver disease (CLD). Hepatic dysfunction, driven by chronic venous congestion and impaired cardiac output, represents a key yet underrecognized determinant of prognosis in this population. The impact of TEER on hepatic function and outcomes in patients with advanced liver disease remains incompletely defined. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. A comprehensive literature search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed up to 16 January 2026, without language restrictions. Studies evaluating mitral or tricuspid TEER in adult patients with cirrhosis, chronic or advanced liver disease, congestive hepatopathy, or cardiohepatic syndrome were included. Hepatic function was assessed using biochemical markers, clinical diagnoses, or composite scores such as Model for End-Stage Liver Disease (MELD) score and Model for End-Stage Liver Disease Excluding INR (MELD-XI). A qualitative synthesis was performed due to heterogeneity in study design and outcome reporting. Results: Twelve studies were included, comprising prospective and retrospective cohorts, registry-based analyses, mechanistic studies, and one illustrative case report. Six studies evaluated mitral TEER (M-TEER) and six tricuspid (T-TEER). Across both valve interventions, impaired baseline hepatic function was consistently associated with increased mortality and adverse clinical outcomes. MELD and MELD-XI scores emerged as robust prognostic markers following both M-TEER and T-TEER. Successful reduction in valvular regurgitation was associated with stabilization or improvement of hepatic parameters in selected patients, particularly after T-TEER. However, advanced cardiohepatic syndrome and limited hepatic reserve were linked to poor outcomes despite procedural success. Conclusions: Hepatic dysfunction is a powerful determinant of prognosis in patients undergoing M-TEER and T-TEER. While TEER may improve hepatic congestion and liver-related parameters in selected patients, outcomes are highly dependent on baseline hepatic reserve and global hemodynamic status. A personalized approach integrating hepatic assessment into patient selection and risk stratification is essential to optimize outcomes in this complex and growing population.