Tricuspid transcatheter edge-to-edge repair versus surgery for tricuspid regurgitation: a systematic review and meta-analysis.

Introduction: To perform a systematic review and meta-analysis to compare the safety, early and late mortality, morbidity and long-term function of the tricuspid valve (TV) following tricuspid transcatheter edge-to-edge repair (T-TEER) compared to surgical tricuspid valve (TV) repair/replacement (TVR) for tricuspid regurgitation (TR).

Methods: This review investigates through two different databases for original studies that evaluated patients with TR who underwent either T-TEER or TVR was until December 2024. The outcomes of interest were safety, morbidity, mortality and long-term function following T-TEER vs TVR.

Results: We identified three retrospective observational studies, including a total of 1612 patients with TR. Short-term (OR, 0.36; 95% CI, 0.13-1.04; p = 0.06) and long-term mortality was similar between T-TEER and TVR. There was a lower risk of acute kidney injury (AKI) (OR, 0.31; 95% CI, 0.23-0.43; p < 0.00001) and permanent pacemaker implantation (PPI) (OR, 0.19; 95% CI, 0.10-0.35; p < 0.00001) with T-TEER, while there was no significant difference in terms of stroke events (OR, 1.17; 95% CI, 0.68-2.01; p = 0.58) and risk of bleeding (OR, 0.81; 95% CI, 0.45-1.44; p = 0.47) compared to TVR.

Conclusions: In conclusion, T-TEER appears to have a comparable safety profile to TVR with a lower risk of AKI and PPI. However, these findings are based on limited observational data and should be interpreted as hypothesis-generating rather than conclusive.

Registration: This systematic review and meta-analysis was prospectively registered on the international prospective register of systematic reviews (PROSPERO; CRD42024622555).