Comparing Transcatheter Tricuspid Valve Intervention With Medical and Surgical Management: A Systematic Review and Meta-Analysis

Transcatheter tricuspid valve intervention (TTVI) is rapidly emerging as an attractive option for patients with tricuspid regurgitation (TR). This study aims to compare the outcomes of transcatheter interventions for TR with conventional surgical and medical management strategies. We conducted a systematic review and meta-analysis that included 11 reports from 10 observational studies. One study compared both TTVI versus medical treatment and TTVI versus surgical treatment. The studies were retrieved through a literature search of PubMed, Scopus, and Embase from their inception until April 2024. The review followed the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Out of six, four studies comparing TTVI with surgical therapy were included in the analysis (due to overlapping populations), while the remaining studies were included in the review. Additionally, five studies comparing TTVI with guideline-directed medical therapy (GDMT) were also incorporated. Patients who underwent TTVI had significantly lower 30-day mortality rates (odds ratio (OR): 0.32, 95% confidence interval (CI): (0.20, 0.50), p < 0.00001), shorter hospital stays (mean difference (MD): -7.33, 95% CI (-8.23, -6.43), p < 0.0001), and lower rates of acute kidney injury (OR: 0.56, 95% CI (0.49, 0.64), p < 0.00001), respiratory complications (OR: 0.45, 95% CI (0.34, 0.60), p = 0.00001), and post-operative cardiogenic shock (OR: 0.31, 95% CI (0.06, 1.53), p = 0.15) when compared to surgical management. TTVI was consistently superior to medical therapy in all included studies, reducing both mortality and heart failure-related hospitalizations. Early intervention with TTVI in patients with low-to-moderate Tricuspid Regurgitation Integrated Score (TRI-SCORE) (recently validated externally, this score captures key outcome drivers, offering a simple and accurate way to predict post-operative mortality and guide the management of patients with TR) was associated with improved outcomes compared to medical therapy alone. Although the available evidence is limited by selection bias and lack of control for confounders, it suggests that TTVI is effective in older, high-risk patients who are considered unsuitable for surgery. Additionally, it shows the superiority of TTVI over medical therapy alone. Future research is necessary to define the optimal candidate profiles for TTVI.