Clinical and echocardiographic outcomes after TEER in secondary tricuspid regurgitation patients: a systematic review and meta-analysis

Background Secondary tricuspid regurgitation (STR) is the major phenotype of TR. Severe STR is associated with substantial morbidity and mortality. The transcatheter edge-to-edge repair (TEER) has emerged as a promising therapeutic alternative for patients at prohibitive surgical risk, current evidence predominantly derives from studies encompassing mixed TR etiologies, leaving a critical gap in the comprehensive assessment of outcomes specifically for the STR population. Objectives This meta-analysis aims to evaluate the safety and clinical efficacy of TEER treatment for significant STR, and to identify clinical and echocardiographic predictors of mortality and residual TR through meta-regression analysis to inform patient selection and risk stratification. Methods Electronic databases were comprehensively searched to identify studies of TEER in patients with STR published up to November 30, 2025. The primary endpoints were perioperative, early, and late all-cause mortality and the incidence of postoperative residual TR. Secondary endpoints included the incidence of clinical events and significant changes in postoperative echocardiographic parameters. Additionally, meta-regression analyses were conducted to explore the determinants of mortality and residual TR. The study design adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Among 18 included studies (2,959 patients), TEER demonstrated a high technical success rate of 96.2%. The procedure resulted in significant and sustained TR reduction, accompanied by evidence of right heart reverse remodeling. All-cause mortality rates were 2.3%, 9.8%and 18.6%, significant residual TR rate (more than moderate) was 20.0%, 26.9%, and 24.8% for periprocedural, early and late follow up, respectively. Meta-regression identified varied predictors for the all-cause mortality and residual TR, including clinical parameters, echocardiographic measurements and comorbidity burden，during the different follow-up stages. Conclusions This meta-analysis confirmed TEER as a technically feasible and safe intervention for high-surgical-risk patients with significant STR, demonstrating high procedural success accompanied by sustained TR reduction, right heart benign remodeling. Varied predictors were associated with mortality and residual TR after TEER, providing valuable information for patient selection and optimized long-term management.Abstract figure