What does this research mean for the field?

In patients with symptomatic moderate-to-severe tricuspid regurgitation, both transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) provide clinically meaningful improvements in functional status and quality of life compared to optimal medical therapy, though neither significantly reduces all-cause mortality and both increase risks of bleeding and pacemaker implantation. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate and compare the efficacy and safety of transcatheter edge-to-edge repair, transcatheter tricuspid valve replacement, and optimal medical therapy alone in patients with moderate-to-severe tricuspid regurgitation.

June 7, 2026Journal of Cardiothoracic SurgeryOpen Access

Comparative efficacy and safety of transcatheter edge-to-edge repair versus tricuspid valve replacement versus optimal medical therapy in moderate-to-severe tricuspid regurgitation: a network meta-analysis of randomized controlled trials

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Moderate-to-severe tricuspid regurgitation (n=1050). Intervention: Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) vs. Optimal medical therapy (OMT). Primary outcome: All-cause mortality (TEER vs OMT) (RR 0.99, 95% CI 0.56-1.76).

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Key result

TEER and TTVR improve NYHA class vs OMT but lack mortality benefit and increase major bleeding.

Why the study?

Severe tricuspid regurgitation causes substantial morbidity and mortality, but the comparative efficacy and safety of emerging transcatheter options (TEER and TTVR) versus optimal medical therapy had not been evaluated via network meta-analysis.

Does transcatheter edge-to-edge repair (TEER) or transcatheter tricuspid valve replacement (TTVR) improve outcomes in patients with symptomatic moderate-to-severe tricuspid regurgitation compared to optimal medical therapy?

Key Points

To evaluate and compare the efficacy and safety of transcatheter edge-to-edge repair, transcatheter tricuspid valve replacement, and optimal medical therapy alone in patients with moderate-to-severe tricuspid regurgitation.
Systematic search of PubMed, Embase, and ScienceDirect through December 2025 identified three multicenter, open-label randomized controlled trials (TRILUMINATE Pivotal, TRISCEND II pivotal, and Tri.Fr).
Enrolled 1,050 patients with symptomatic moderate-to-severe or severe tricuspid regurgitation receiving stable optimal medical therapy across a star-shaped network with medical therapy as the common comparator.
Conducted frequentist random-effects and Bayesian network meta-analyses to evaluate mortality, functional status, quality of life, and adverse events.
Neither transcatheter edge-to-edge repair (RR 0.99, 95% CI 0.56–1.76) nor transcatheter tricuspid valve replacement (RR 0.85, 95% CI 0.51–1.41) significantly reduced all-cause mortality compared with medical therapy alone.
Both interventions significantly improved New York Heart Association class by ≥ 1 class (TEER RR 1.46, 95% CI 1.30–1.64, NNT 8; TTVR RR 3.28, 95% CI 2.41–4.47, NNT 2) and Kansas City Cardiomyopathy Questionnaire overall summary scores (TEER MD +11.00, 95% CI 7.46–14.54; TTVR MD +17.80, 95% CI 12.78–22.82).
Both procedures increased risks of major bleeding (TEER NNH 29; TTVR NNH 21) and new pacemaker implantation (TEER NNH 91; TTVR NNH 10), with valve replacement showing only a 1% Bayesian probability of being best for pacemaker avoidance.

Study Design

Type

Meta-Analysis (n=1,050)

Structured PICO

Population

1,050 patients with symptomatic moderate-to-severe tricuspid regurgitation despite optimal medical therapy included in a network meta-analysis of 3 RCTs.

Intervention

Transcatheter edge-to-edge repair (TEER) or transcatheter tricuspid valve replacement (TTVR) added to optimal medical therapy

Comparator

Optimal medical therapy (OMT) alone

Outcome

All-cause mortality

Main Result

Relative Risk: 0.99 (95% CI 0.56–1.76)

In patients with symptomatic moderate-to-severe tricuspid regurgitation, TEER and TTVR provide clinically meaningful improvements in functional status and quality of life compared to medical therapy, though they do not reduce mortality and carry increased risks of bleeding and pacemaker implantation.

Limitations

No direct TEER-TTVR comparison
Lack of longer-term trials
No direct head-to-head TEER-TTVR comparison (star-shaped network)
Need for longer-term trials

Discussion

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Implication

TEER/TTVR may be considered for symptom relief in tricuspid regurgitation despite risks; reinforces lack of mortality benefit in Level-1 evidence.

Cite This Study

Veettil et al. (2026) conducted a meta-analysis in Moderate-to-severe tricuspid regurgitation (n=1,050). Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) vs. Optimal medical therapy (OMT) was evaluated on All-cause mortality (TEER vs OMT) (RR 0.99, 95% CI 0.56-1.76). TEER and TTVR improved NYHA class (RR 1.46 and 3.28) vs medical therapy but did not reduce mortality (RR 0.99 and 0.85) and increased major bleeding (NNH 29 and 21).

synapsesocial.com/papers/6a250fa07def13d035e1d44e https://doi.org/10.1186/s13019-026-04265-9

Topics

Tricuspid regurgitation

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Implication

TEER/TTVR may be considered for symptom relief in tricuspid regurgitation despite risks; reinforces lack of mortality benefit in Level-1 evidence.

Comparative efficacy and safety of transcatheter edge-to-edge repair versus tricuspid valve replacement versus optimal medical therapy in moderate-to-severe tricuspid regurgitation: a network meta-analysis of randomized controlled trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Comparative efficacy and safety of transcatheter edge-to-edge repair versus tricuspid valve replacement versus optimal medical therapy in moderate-to-severe tricuspid regurgitation: a network meta-analysis of randomized controlled trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider