Transcatheter tricuspid valve replacement for severe tricuspid regurgitation resulted in a pooled 30-day mortality of 2.49% and a new permanent pacemaker implantation rate of 7.98%.
Meta-Analysis (n=1,017)
Does transcatheter tricuspid valve replacement improve clinical outcomes in adult patients with severe or torrential tricuspid regurgitation?
TTVR is a feasible and safe intervention for severe TR, associated with low early mortality and significant functional improvement, though pacemaker implantation rates remain notable.
Background: Tricuspid regurgitation (TR) is associated with substantial morbidity and mortality, yet it remains an undertreated entity. Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising therapeutic option, with multiple novel systems demonstrating early safety and efficacy. The objective of this study is to systematically review and synthesize the clinical outcomes of transcatheter heart valve systems. Methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted from database inception through March 31, 2025. Eligible studies included adult patients undergoing TTVR for severe or torrential TR, reporting at least one clinical outcome. Pooled event rates were calculated using a random-effects model. Subgroup analyses were performed by valve type, and meta-regression explored potential sources of heterogeneity. Results: Twenty studies comprising 1017 patients were included. The mean age was 73 ± 9 years, and 71.2% were female. The weighted in-hospital and 30-day mortality were 1.37 and 2.49%, respectively. New permanent pacemaker implantation occurred in 7.98%, with highest rates observed in EVOQUE recipients (11.64%). Only 3% of patients had greater than or equal to severe TR at follow-up, and only 12% remained in New York Heart Association functional class III/IV. Subgroup analysis revealed lower in-hospital and 30-day mortality with EVOQUE but higher permanent pacemaker implantation compared to other valves. Conclusions: TTVR is a feasible and safe intervention for patients with severe TR, providing significant functional improvement and TR reduction. Robust, longer-term randomized controlled trials with standardized outcome reporting and clinical endpoints are urgently needed to define durable clinical benefit and guide optimal device selection for patients with severe TR.
Hatab et al. (Fri,) conducted a meta-analysis in Severe or torrential tricuspid regurgitation (n=1,017). Transcatheter tricuspid valve replacement (TTVR) was evaluated on 30-day mortality. Transcatheter tricuspid valve replacement for severe tricuspid regurgitation resulted in a pooled 30-day mortality of 2.49% and a new permanent pacemaker implantation rate of 7.98%.