July 21, 2026Open Access
Transcatheter Tricuspid Valve Annuloplasty vs Edge-to-Edge Repair: A Propensity-Matched Multicenter Comparative Analysis.
Jennifer von SteinP Von SteinLukas StolzCaroline HasseSebastian RoschFelix RudolphJohannes KirchnerBjoern GoebelBenedikt KoellWolfgang RottbauerTienush RassafHarald BeucherMartin KrausMohammad KassarTobias GeislerAndreas RückJoao Ferreira-MartinsStefan ToggweilerPaula SagmeisterDirk WestermannThomas J. StockerLudwig T. WeckbachMichael NäbauerSam DawkinsTobias KisterMarc VorpahlMathias H. KonstandinPeter LuedikeMirjam KesslerChristos IliadisPhilipp LautenChristian BeslerDaniel KalbacherKai FriedrichsMuhammed GerçekJuan F. GranadaPhilipp LurzJörg HausleiterMirjam G. WildMaria Isabel Körber
Key result
T-TEER yields similar 1-year mortality and HF hospitalization as annuloplasty, with fewer procedural complications.
- P=0.408
- n=1,122
Why the study?
Comparative data on procedural and clinical outcomes between transcatheter edge-to-edge repair and transcatheter tricuspid valve annuloplasty for severe secondary tricuspid regurgitation remain limited.
Does transcatheter edge-to-edge repair compared to transcatheter tricuspid valve annuloplasty improve procedural and clinical outcomes in patients with severe secondary tricuspid regurgitation?
Key Points
- To compare procedural safety and clinical outcomes between transcatheter tricuspid valve edge-to-edge repair (T-TEER) and transcatheter tricuspid valve annuloplasty (TTVA) in patients with severe secondary tricuspid regurgitation.
- Multicenter cohort evaluation of 1,122 consecutive patients treated with T-TEER (n=882) or TTVA (n=240) between 2017 and 2024.
- Performed 1:1 propensity-score matching to create 111 well-balanced pairs to assess procedural complications, residual regurgitation, and 1-year clinical endpoints.
- At discharge, T-TEER yielded higher rates of residual tricuspid regurgitation ≤1+ (50.0% vs 34.2%) and ≤2+ (87.7% vs 67.6%; all P < 0.05) compared with TTVA, alongside significantly fewer procedural complications (4.5% vs 27.0%; P < 0.001).
- Freedom from the composite endpoint of all-cause mortality or first heart failure hospitalization at 1 year was 75.0% (95% CI: 66.8–84.1) for T-TEER versus 79.8% (95% CI: 72.4–87.9) for TTVA (P = 0.408), with similar rates of reintervention and symptom improvement.
Study Design
Type
Cohort (n=1,122)
Multicenter
Yes
Structured PICO
Does transcatheter edge-to-edge repair compared to transcatheter tricuspid valve annuloplasty improve procedural and clinical outcomes in patients with severe secondary tricuspid regurgitation?
P
Population
1,122 patients with severe secondary tricuspid regurgitation undergoing T-TEER or TTVA, evaluated using 1:1 propensity-score matching (111 matched pairs) with 1-year follow-up.
E
Exposure
Transcatheter edge-to-edge repair (T-TEER)
C
Comparator
Transcatheter tricuspid valve annuloplasty (TTVA)
O
Outcome
Composite of all-cause mortality or first heart failure hospitalization within 1 year, residual TR ≤ 1+/≤2+, and ≥2-grade reductioncomposite
Main Result
Absolute Event Rate: 75% vs 79.8%
p-value: p=0.408
T-TEER offers a more favorable safety profile and more effective early TR reduction compared to TTVA, though 1-year clinical outcomes appear comparable.
Limitations
- Need for longer-term evaluation to assess durability of clinical outcomes.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These findings highlight the importance of procedural safety and durable TR reduction, while underscoring the complexity of translating procedural success into early clinical benefit and the need for longer-term evaluation.”
Implication
Similar 1-year outcomes after T-TEER versus TTVA; leaves open randomized trials to guide device selection in severe tricuspid regurgitation.
Abstract
Background Transcatheter tricuspid valve (TV) interventions are an effective treatment option for patients with severe symptomatic tricuspid regurgitation (TR). TV transcatheter edge-to-edge repair (T-TEER) and transcatheter TV annuloplasty (TTVA) represent distinct repair strategies; however, comparative data remain limited.Objectives The objective of the study was to compare procedural and clinical outcomes after T-TEER and TTVA in patients with severe secondary TR.Methods Consecutive T-TEER or TTVA-treated patients (2017-2024) were included. A 1:1 propensity-score matching was performed. Endpoints included residual TR ≤ 1+/≤2+, a ≥2-grade reduction, procedural complications, symptomatic improvement, reinterventions, and the composite of all-cause mortality or first heart failure hospitalization within 1 year.Results Among 1,122 patients (882 T-TEER; 240 TTVA), 111 well-balanced matched pairs were identified. At discharge, T-TEER achieved higher rates of residual TR ≤ 1+ (50.0% vs 34.2%) and ≤2+ (87.7% vs 67.6%; all P < 0.05) compared with TTVA, whereas a ≥2-grade reduction was comparable. Procedural complications were less frequent with T-TEER (any complication: 4.5% vs 27.0% for T-TEER vs TTVA; P < 0.001). Symptomatic improvement and reintervention rates within 1 year were similar between groups. Freedom from the composite endpoint of all-cause mortality or first heart failure hospitalization at 1-year was 75.0% (95% CI: 66.8-84.1) after T-TEER and 79.8% (95% CI: 72.4-87.9) after TTVA (P = 0.408).Conclusions In patients with severe secondary TR and sufficient clinical and anatomical overlap for matched comparison, T-TEER showed a more favorable safety profile and more effective, durable TR reduction, whereas early clinical outcomes at 1 year were comparable after adjustment for baseline differences, highlighting the need for longer-term evaluation.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Stein et al. (2026) conducted a cohort in Severe secondary tricuspid regurgitation (n=1,122). Transcatheter tricuspid valve edge-to-edge repair (T-TEER) vs. Transcatheter tricuspid valve annuloplasty (TTVA) was evaluated on Freedom from the composite endpoint of all-cause mortality or first heart failure hospitalization at 1-year (p=0.408). Transcatheter edge-to-edge repair yielded similar 1-year freedom from mortality or heart failure hospitalization compared to annuloplasty (75.0% vs 79.8%; P=0.408), with fewer procedural complications.