Transcatheter Tricuspid Valve Intervention Plus Optimized Medical Therapy Versus Optimized Medical Therapy Alone in Tricuspid Regurgitation: A Systematic Review and Meta-Analysis

Tricuspid regurgitation (TR) is common and associated with substantial morbidity and mortality. Although optimized medical therapy (OMT) can alleviate symptoms, it may be insufficient in severe cases, and surgical interventions carry considerable procedural risk, limiting their use; consequently, tricuspid transcatheter valve interventions (TTVIs) have emerged as a less invasive alternative. We conducted a systematic search of PubMed, Scopus, and Web of Science to identify randomized clinical trials and observational studies comparing TTVI plus OMT versus OMT alone. The primary outcome was all-cause mortality, and secondary outcomes included heart failure (HF) hospitalization and a combined outcome of all-cause mortality and HF hospitalization. Eight studies (five observational and three randomized trials) comprising 4836 patients were included. Compared with OMT alone, TTVI plus OMT was associated with a significant reduction in all-cause mortality (HR = 0.59, 95% CI: 0.44–0.78, P < 0.001) and HF hospitalization (HR = 0.69, 95% CI: 0.49–0.96, P = 0.03), and it significantly reduced the combined outcome (HR = 0.59, 95% CI: 0.47–0.74, P < 0.001). However, subgroup analysis showed that the mortality benefit was driven primarily by observational studies (HR = 0.48, 95% CI: 0.37–0.61), whereas randomized trials demonstrated no significant difference (HR = 0.88, 95% CI: 0.75–1.03). Overall, TTVI combined with OMT may be associated with lower mortality and HF hospitalization compared with OMT alone, although the apparent benefit is largely derived from non-randomized evidence.