Transcatheter tricuspid valve intervention reduced all-cause mortality compared with optimal medical therapy in pooled analyses (OR 0.70; p=0.009), but this was not confirmed in RCT-only analyses.
Meta-Analysis (n=6,732)
Does transcatheter tricuspid valve intervention reduce mortality and adverse clinical events compared with optimal medical therapy in patients with severe symptomatic tricuspid regurgitation?
TTVI is associated with reduced all-cause mortality in symptomatic TR when pooling observational and randomized data, but the lack of benefit in RCT-only analyses highlights the need for cautious interpretation due to potential confounding.
Effect estimate: OR 0.70
p-value: p=0.009
BACKGROUND: Severe symptomatic tricuspid regurgitation (TR) is associated with a poor prognosis, and many patients are ineligible for surgical intervention. Transcatheter tricuspid valve intervention (TTVI) has emerged as a less invasive alternative, but its impact on clinical outcomes compared with optimal medical therapy (OMT) remains uncertain. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing TTVI (transcatheter edge-to-edge repair or valve replacement) with OMT. Databases were searched from inception through December 31, 2025. Outcomes included all-cause and cardiovascular mortality, heart failure (HF) hospitalization, myocardial infarction, stroke, bleeding, and new permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) implantation. Random-effects models were used to calculate pooled odds ratios (ORs). RESULTS: Thirteen studies encompassing 6732 patients (3240 TTVI; 3492 OMT) were included. In pooled analyses of randomized and observational studies, TTVI was associated with a significant reduction in all-cause mortality compared with OMT (OR 0.70; p=0.009). However, this benefit was not observed in an RCT-only analysis. No significant differences were noted in cardiovascular mortality, HF hospitalization, myocardial infarction, severe bleeding, or stroke. A non-significant trend toward increased PPM/ICD implantation (p=0.06) was primarily driven by valve replacement devices. CONCLUSIONS: In symptomatic TR, TTVI was associated with reduced all-cause mortality in pooled analyses incorporating both randomized and observational data; however, this benefit was not confirmed in RCT-only analyses, likely reflecting residual confounding in non-randomized studies which may overestimate treatment effects. These findings support TTVI as an effective therapeutic option for appropriately selected high-risk patients.
Banga et al. (Fri,) conducted a meta-analysis in Symptomatic tricuspid regurgitation (n=6,732). Transcatheter tricuspid valve intervention (TTVI) vs. Optimal medical therapy (OMT) was evaluated on All-cause mortality (OR 0.70, p=0.009). Transcatheter tricuspid valve intervention reduced all-cause mortality compared with optimal medical therapy in pooled analyses (OR 0.70; p=0.009), but this was not confirmed in RCT-only analyses.