Functional, echocardiographic outcomes and complications after Transcatheter Tricuspid Edge-to-Edge Repair (T-TEER): a systematic review and meta-analysis
F Giacobbe, M D'Amica, M Michelone, M Nebiolo, J M Rampone, F D'Ascenzo, M Caria, M C Ferrua, F Bruno, G M De FerrariAbstract
Background
Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality, yet surgical treatment is often deferred due to elevated operative risk. Transcatheter tricuspid edge-to-edge repair (T-TEER) has emerged as a less invasive therapeutic alternative. We performed a systematic review and meta-analysis to evaluate clinical, echocardiographic, and safety outcomes after T-TEER.
Methods
Following PRISMA and Cochrane recommendations, PubMed, EMBASE, and Scopus were searched through June 10, 2025. Randomized and observational studies including ≥20 patients undergoing T-TEER were eligible. Primary endpoints were procedural success and all-cause mortality at latest follow-up. Secondary endpoints included T-VARC-defined safety outcomes, functional status, quality of life, and echocardiographic parameters. Random-effects models were applied.
Results
Thirty-two studies (3 RCTs, 29 observational) including 7,563 patients were analyzed. Patients were elderly (median age 78 years), predominantly female (57%), and highly symptomatic (87.5% NYHA III–IV; 97.6% ≥ severe TR; median LVEF 56%). Procedural success was achieved in 87.0% of cases. T-TEER significantly reduced severe TR (RR 0.39, 95% CI 0.30–0.51; p<0.001) and TR effective regurgitant orifice area (MD –0.37 cm²; p<0.001), with concomitant reductions in right ventricular dimensions and inferior vena cava diameter, suggesting reverse right heart remodeling. A modest but significant decline in TAPSE and FAC was observed, while LVEF and sPAP remained unchanged. Functional status improved markedly, with fewer patients in NYHA III–IV (RR 0.44; p<0.001), increased 6-minute walk distance (MD +42.4 m; p<0.001), and higher KCCQ scores (MD +15.3 points; p<0.001). At latest follow-up, all-cause mortality was 10.1% and cardiovascular mortality 6.9%. Stroke (1.5%), major vascular complications (0.8%), and need for tricuspid surgery (0.9%) were infrequent, whereas major bleeding occurred in 6.3%.
Conclusions
In a high-risk, predominantly symptomatic population with advanced TR, T-TEER provides high procedural success, significant reduction in regurgitation severity, reverse right heart remodeling, and meaningful improvements in functional capacity and quality of life, with acceptable safety outcomes. These findings support T-TEER as an effective therapeutic option in appropriately selected patients, although longer-term randomized evidence is needed.