Tricuspid Transcatheter Edge-to-Edge Repair Versus Medical Management for Tricuspid Regurgitation: A Systematic Review and Meta-Analysis

Background: Severe tricuspid regurgitation (TR) is associated with poor prognosis, and guideline-directed medical therapy (GDMT) alone has limited efficacy. Transcatheter edge-to-edge repair (T-TEER) has emerged as a promising therapeutic option, but its impact on clinical outcomes remains debated. Aims: Evaluation of the efficacy and safety of T-TEER compared to GDMT. Methods: PubMed, EMBASE and Cochrane Central were searched for clinical trials and observational studies through February 2025, for studies comparing the clinical outcomes of T-TEER to GDMT. The outcomes assessed were all-cause mortality, heart failure hospitalization (HFH), cardiovascular mortality, residual TR, NYHA class improvement, stroke and new permanent pacemaker (PPM) implantation. Random-effects models were used to calculate pooled risk ratios (RR) or hazard ratios (HR) with corresponding 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. Subgroup analysis was done based on study design. Results: Seven studies with 4220 patients were included. T-TEER was associated with a significant reduction in mortality (HR: 0.79; 95% CI: 0.64–0.98; p = 0.03) and HFH (HR: 0.69; 95% CI: 0.53–0.91; p < 0.01) compared to GDMT. No difference was observed in cardiovascular mortality (RR: 0.96; 95% CI: 0.37–2.52) or stroke (RR: 1.06; 95% CI: 0.32–3.56). T-TEER significantly improved TR severity (RR: 9.12; 95% CI:4.43–18.77; p < 0.001) and reduction in NYHA functional class (RR: 2.37; 95% CI: 1.15–4.88; p = 0.019), without increasing the risk of new PPM implantation (RR: 1.83; 95% CI: 0.80–4.21; p = 0.153). Conclusion: T-TEER is associated with improved survival, a lower risk of HFH, higher reduction in NYHA class and effective TR severity reduction without significantly increasing the risk of stroke or the need for PPM implantation. Further studies would be needed to identify optimal patient subgroup based on disease severity and clinical phenotype.