Key result
TriClip and PASCAL T-TEER devices yielded similar residual TR ≤2+ at discharge (82.7% vs 84.7%, p=0.456) and comparable 2-year survival (HR 0.90; 95% CI 0.70-1.71; p=0.444).
Why the study?
Two transcatheter tricuspid valve edge-to-edge repair (T-TEER) devices are commercially available in Europe for severe tricuspid regurgitation at prohibitive surgical risk, but their efficacy had not been compared.
Does transcatheter tricuspid valve edge-to-edge repair using TriClip compared to PASCAL improve procedural performance, durability of TR reduction, and clinical outcomes in patients with severe tricuspid regurgitation?
Observational (n=1,814)
Yes
Does transcatheter tricuspid valve edge-to-edge repair using TriClip compared to PASCAL improve procedural performance, durability of TR reduction, and clinical outcomes in patients with severe tricuspid regurgitation?
In a large real-world European registry, the TriClip and PASCAL T-TEER devices demonstrated comparable tricuspid regurgitation reduction, symptomatic improvement, right ventricular reverse remodeling, and two-year clinical outcomes.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Particularly in the context of the increasing use of transcatheter tricuspid valve replacement (TTVR), this finding is of considerable clinical relevance, as the latter almost always completely eliminates TR. It raises the question of whether patients at high risk for residual TR (even if only moderate) might benefit from being treated primarily with a TTVR strategy rather than T-TEER.”
Comparable real-world outcomes support flexible device selection by anatomy or availability; leaves open randomized confirmation of equivalence.
Background Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has developed as a treatment option for patients presenting with severe tricuspid regurgitation (TR) at prohibitive surgical risk. While two T-TEER devices are commercially available in Europe, their efficacy has not been compared. Objective To compare procedural performance, durability of TR reduction, and clinical outcomes according to T-TEER device. Methods Data were taken from the EuroTR (European Registry of Transcatheter Intervention for Tricuspid Regurgitation) registry and included patients undergoing T-TEER in 26 European centers between 2016 and 2024. Characteristics and outcomes of patients were compared at discharge and latest follow-up, according to the device used, in the global population and after propensity score matching. Results Overall, 1,814 consecutive patients treated with T-TEER were included (824 with TriClip and 990 with PASCAL). After propensity matching creating two balanced groups of 713 patients each, improvement in TR was observed in both groups with similar rates of residual TR≤2+ at discharge and follow-up (82.7% vs. 84.7%, p=0.456; and: 64.6% vs. 71.6%, p=0.093; for TriClip vs. PASCAL, respectively). Symptomatic improvement at one year was similar in both cohorts (NYHA class ≤ II TriClip vs. PASCAL: 63.7% vs. 62.8%, p=0.833). Significant right ventricular reverse remodeling was observed with both devices (TriClip: difference in right ventricular end-diastolic area from -2.2 [IQR -6.7 to 2.6] cm2, p=0.018, PASCAL: -2.4 [IQR -7.2 to 2.4] cm2, p=0.001). There was no difference in Kaplan–Meier estimates of two-year survival and survival free from heart failure hospitalization (HR 0.90, 95%CI 0.70- 1.71, p=0.444 and HR 1.11, 95%CI 0.90-1.37, p=0.349). Conclusions TriClip and PASCAL yielded comparable TR reduction, symptomatic improvement, right ventricular reverse remodeling and two-year survival free from heart failure hospitalizationTwo-year survival stratified by device type
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Stolz et al. (2026) conducted an observational in Severe tricuspid regurgitation (n=1,814). TriClip T-TEER vs. PASCAL T-TEER was evaluated on Residual tricuspid regurgitation ≤2+ at discharge and two-year survival (HR 0.90, 95% CI 0.70-1.71, p=0.444). TriClip and PASCAL T-TEER devices yielded similar residual TR ≤2+ at discharge (82.7% vs 84.7%, p=0.456) and comparable 2-year survival (HR 0.90; 95% CI 0.70-1.71; p=0.444).
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