Abstract
BACKGROUND: Severe tricuspid regurgitation (TR) is strongly associated with high mortality and morbidity. This meta-analysis aims to compare the outcomes of transcatheter tricuspid valve intervention (TTVI) versus optimal medical treatment (OMT) alone among patients with severe TR. METHODS: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched observational studies comparing TTVI with OMT. The primary outcome was all-cause mortality. Summary estimates were calculated using a random-effects model. RESULTS: Five studies (3 RCTs, 2 observational; n = 1988 patients) were included. TTVI was associated with a nonsignificant trend toward a lower incidence of all-cause mortality (risk ratio [RR]: 0.70, 95 % confidence interval [CI] 0.48-1.03; P = 0.071), primarily driven by observational studies. TTVI demonstrated significant benefits in terms of TR severity reduction (RR: 7.82, 95 % CI 5.60-10.93; P < 0.0001), enhanced health status as measured by the Kansas City Cardiomyopathy Questionnaire (mean difference: +14.46 points, 95 % CI 11.55-17.38; p < 0.0001), and reduced heart failure (HF) hospitalization rates (RR: 0.73, 95 % CI 0.56-0.96; P = 0.025). However, TTVI was associated with an increased risk of major bleeding (RR: 3.21, 95 % CI 1.61-6.39; P = 0.0009). CONCLUSION: Among patients with severe TR, TTVI was not statistically associated with a lower incidence of all-cause mortality but was associated with a reduced risk of HF hospitalization, significant reduction in TR severity, and improved quality of life. Future large RCTs with extended follow-up are needed to confirm these findings and identify the subset of patients who benefit the most.Systematic review protocol: CRD420251002402 (PROSPERO).