Outcomes of transcatheter edge-to-edge repair versus transcatheter valve replacement with the cardiovalve system for tricuspid regurgitation

Abstract Background Tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Since surgical treatment of tricuspid regurgitation in elderly, multimorbid patients is associated with high risk, less invasive therapies such as tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) have been developed. Objectives This study aimed to compare 30-day clinical and echocardiographic outcomes of T-TEER and TTVR in high-risk patients with severe TR. Methods T-TEER was performed in 104 patients and TTVR in 10 patients based on anatomical suitability. All procedures were guided by transesophageal echocardiography and fluoroscopy. Primary endpoints included TR reduction, NYHA functional class, and safety events according to TVARC criteria. Results At 30 days, TR reduction to grade 0/I was achieved in 44.9% of T-TEER and 80% of TTVR patients ( p < 0.001). NYHA class I/II was present in 63.2% after T-TEER and 70% following TTVR ( p = 0.69). Major bleeding occurred more frequently in the TTVR group (20%) than in the T-TEER group (1.96%; p = 0.041). One patient in the TTVR group required a new pacemaker. No deaths, strokes, or surgical conversions occurred in either group. Conclusions T-TEER and TTVR are effective for treating severe TR in high-risk patients. TTVR achieved greater TR reduction but was associated with more access site bleeding. T-TEER demonstrated a favorable safety profile. Careful patient selection remains essential to optimize outcomes. Graphical Abstract