Transcatheter Therapy for Severe Symptomatic Tricuspid Regurgitation: A Systematic Review and Network Meta-Analysis of Randomized Trials

Introduction: Tricuspid regurgitation (TR) is a common valvular disorder primarily affecting older adults and imposing an increasing burden on healthcare systems worldwide. The efficacy and safety of transcatheter therapy for TR remain uncertain, highlighting the need for further investigation. Methods: A comprehensive literature search was conducted across four databases—PubMed, Embase, Cochrane Library, and Web of Science—to identify randomized controlled trials (RCTs) comparing transcatheter therapy with medical treatment. The primary outcome was improvement in the New York Heart Association (NYHA) functional classification. Secondary outcomes included all-cause mortality, hospitalization rates, quality of life (QOL), and the risk of pacemaker implantation. Results: Four RCTs involving 1,070 patients were included. Transcatheter therapy significantly improved the NYHA functional class, with an odds ratio (OR) of 3.78 (95% confidence interval [CI]: 1.56–9.17, p = 0.003), and QOL, as assessed by the summary score of the Kansas City Cardiomyopathy Questionnaire, with a mean difference of 12.39 (95% CI: 7.52–17.27, p < 0.001). However, it did not demonstrate a significant benefit in reducing all-cause mortality (OR: 1.08, 95% CI: 0.74–1.58, p = 0.68) or hospitalization risk (OR: 0.98, 95% CI: 0.68–1.41, p = 0.92). Notably, an increased risk of pacemaker implantation was observed (OR: 8.55, 95% CI: 2.94–24.85, p < 0.001). Conclusion: Transcatheter therapy improves functional capacity and QOL in patients with severe symptomatic TR but does not significantly affect mortality or hospitalization rates. The elevated risk of pacemaker implantation underscores the importance of careful patient selection.