Outcomes of tricuspid transcatheter edge-to-edge repair in patients with cardiac implantable electronic devices: a systematic review and meta-analysis

Background Transvenous cardiac implantable electronic device (CIED) leads across the tricuspid valve may present anatomical challenges for transcatheter edge-to-edge repair (T-TEER). However, the safety and efficacy of T-TEER in these patients are unclear. Methods We conducted a systematic search of PubMed, Embase, and Cochrane Library from inception through November 2025 for studies comparing T-TEER in patients with versus without transvalvular CIED leads. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results Six studies comprising 4,891 patients (1,240 with and 3,651 without CIEDs) were included. Procedural success was comparable between the two groups (RR 1.00, 95% CI 0.98–1.02, p=0.96; I2=0%). At discharge, successful TR reduction (≤ 2) was similarly achieved in both cohorts (RR 0.99, 95% CI 0.94–1.04, p=0.60; I2=0%), with results remaining comparable for sustained TR ≤ 2 (RR 0.96, 95% CI 0.90–1.02, p=0.20; I2=0%) and functional improvement to NYHA class ≤ II (RR 0.95, 95% CI 0.89–1.01, p=0.12; I2=0%) at mid-term follow-up. CIED presence was not statistically associated with an increased risk of all-cause mortality, cardiovascular mortality, heart failure-related hospitalization, or tricuspid reintervention. Conclusion In this meta-analysis, procedural success, sustained TR reduction, and mid-term clinical outcomes were similar between patients undergoing T-TEER with and without CIEDS leads, supporting T-TEER as a feasible and safe option in selected patients.