Transcatheter Edge–to–edge Repair for Tricuspid Regurgitation – Systematic Review and Meta–analysis

Background Severe tricuspid regurgitation (TR) is associated with significant morbidity, reduced exercise capacity and impaired quality of life, while many patients are at prohibitive surgical risk. Transcatheter tricuspid edge–to–edge repair (T–TEER) using TriClip™, MitraClip™ or PASCAL™ has emerged as a less invasive alternative, but pooled evidence on reverse remodeling, functional status and quality–of–life (QoL) outcomes remains limited. Objectives To perform a systematic review and meta–analysis of studies reporting pre– and post–T–TEER outcomes in patients with at least severe TR, focusing on clinical, functional and echocardiographic outcomes. Methods MEDLINE/PubMed, Embase, Scopus and Google Scholar were searched from inception to May 2025 following PRISMA/Cochrane methodology. Studies reporting paired pre– and post–T–TEER data were included. Data extraction and quality assessment were independently performed, and pooled analyses of echocardiographic, clinical and QoL outcomes were conducted. Results Thirty studies (n = 7,563 patients) met inclusion criteria. Pooled analyses demonstrated a significant reduction in severe or greater TR following T–TEER (RR = 0.39; 95% CI 0.30 to 0.51), with a decrease in effective regurgitant orifice area (EROA; MD = −0.37 cm²; 95% CI −0.42 to −0.31). Right ventricular size decreased: basal RVEDD MD = −3.44 mm (95% CI −4.68 to −2.20) and mid RVEDD MD = −4.40 mm (95% CI −7.92 to −0.88). Markers of venous congestion improved with a smaller IVC diameter (MD = −2.28 mm; 95% CI −4.50 to −0.05). There was a small deterioration in RV contractile indices (RV–FAC MD = −2.02%; 95% CI −3.68 to −0.36; TAPSE MD = – 0.57 mm; 95% CI – 1.12 to – 0.02) and a modest, non–statistically significant change in LVEF (MD = −1.73%; 95% CI −4.94 to 1.47). Clinically meaningful benefits were evident, with fewer patients in NYHA class III–IV (RR = 0.44; 95% CI 0.38–0.51), 6MWD increased (MD = +42.4 m; 95% CI 28.2–56.6), and KCCQ score improved (MD = +15.3 points; 95% CI 12.9–17.7). Cardiovascular and all–cause mortality were 6.9% and 10.1%, respectively, with low rates of major complications, Conclusion T–TEER is an effective and safe treatment option for high–risk patients with severe TR, providing significant reduction in regurgitation, favourable right ventricular remodelling and consistent improvements in symptoms, exercise capacity and QoL