Clinical Outcomes Following Transcatheter Tricuspid Valve Replacement – A Meta-Analysis

Background: Tricuspid regurgitation (TR) is associated with substantial morbidity and mortality, yet it remains an undertreated entity. Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising therapeutic option, with multiple novel systems demonstrating early safety and efficacy. The objective of this study is to systematically review and synthesize the clinical outcomes of transcatheter heart valve systems. Methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted from database inception through March 31, 2025. Eligible studies included adult patients undergoing TTVR for severe or torrential TR, reporting at least one clinical outcome. Pooled event rates were calculated using a random-effects model. Subgroup analyses were performed by valve type, and meta-regression explored potential sources of heterogeneity. Results: Twenty studies comprising 1017 patients were included. The mean age was 73 ± 9 years, and 71.2% were female. The weighted in-hospital and 30-day mortality were 1.37 and 2.49%, respectively. New permanent pacemaker implantation occurred in 7.98%, with highest rates observed in EVOQUE recipients (11.64%). Only 3% of patients had greater than or equal to severe TR at follow-up, and only 12% remained in New York Heart Association functional class III/IV. Subgroup analysis revealed lower in-hospital and 30-day mortality with EVOQUE but higher permanent pacemaker implantation compared to other valves. Conclusions: TTVR is a feasible and safe intervention for patients with severe TR, providing significant functional improvement and TR reduction. Robust, longer-term randomized controlled trials with standardized outcome reporting and clinical endpoints are urgently needed to define durable clinical benefit and guide optimal device selection for patients with severe TR.