Outcomes of tricuspid transcatheter edge-to-edge repair in patients with versus without transvalvular cardiac implantable electronic device leads: a systematic review and meta-analysis

Background A substantial proportion of patients undergoing tricuspid transcatheter edge-to-edge repair (TEER) have transvalvular cardiac implantable electronic device (CIED) leads, raising concern about leaflet grasping, residual tricuspid regurgitation (TR), and clinical outcomes. Methods Using PRISMA methodology, we performed a systematic review and meta-analysis of studies identified in PubMed, Scopus, Web of Science, and the Cochrane Library from inception through December 2025. We included studies comparing tricuspid TEER outcomes in adults with transvalvular CIED leads versus those without CIEDs. The primary outcome was post-TEER TR severity (grades I–V), while secondary outcomes included procedure duration, all-cause mortality and tricuspid valve reintervention. Pooled estimates were calculated using random-effects models with restricted maximum likelihood (REML). Results Five eligible studies (n = 1825; 628 with CIED, 1197 without) were included. Post-TEER TR grades I–III did not differ between groups (Grade I: RR 0.93, 95% CI 0.77–1.13; Grade II: RR 0.95, 95% CI 0.81–1.12; Grade III: RR 1.13, 95% CI 0.88–1.46). Patients with CIED leads had a higher risk of residual TR Grade IV (RR 2.02, 95% CI 1.23–3.32), while Grade V did not differ (RR 1.81, 95% CI 0.64–5.16). Procedure duration was similar (MD − 7.90 min, 95% CI − 24.22 to 8.41), as were all-cause mortality (RR 0.97, 95% CI 0.61–1.54) and TV reintervention (RR 1.31, 95% CI 0.54–3.18). Conclusions In selected patients undergoing tricuspid TEER, transvalvular CIED leads do not appear to preclude meaningful TR reduction or clinical stability. However, lead-bearing anatomy may still predispose to residual Grade IV TR, supporting careful, mechanism-based Heart Team assessment for patient selection and procedural planning.