Predictors of Procedural and Clinical Outcomes Following Transcatheter Tricuspid Edge-to-Edge Repair: An Expert Overview.
This PRISMA-compliant systematic review and meta-analysis (59 studies, registered CRD42024600438) sought to identify multivariable predictors of T-TEER outcomes.
The strongest signal was residual TR ≥3+, which was associated with all-cause mortality (HR 2.19, 95% CI 1.60-3.00) and MACE (HR 1.84, 95% CI 1.37-2.48) with essentially no heterogeneity (I² 0-2%).
Predictors of residual TR included baseline TR severity (OR 2.50), nonanteroseptal jet location (OR 2.46), and coaptation gap (HR 1.19 per mm).
Markers of advanced disease substrate — renal dysfunction, RV dysfunction, pulmonary hypertension, RV-PA uncoupling — were consistently associated with adverse outcomes.
Tricuspid transcatheter edge-to-edge repair alleviates symptoms, but survival benefit remains inconsistent. The authors conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review and meta-analysis (CRD42024600438) to identify multivariable predictors of procedural success and adverse outcomes. PubMed, Scopus, the Cochrane Library, and Google Scholar were searched (from January 2008 to March 2025) for adjusted predictors of mortality, heart failure hospitalization, major adverse cardiovascular events, and procedural success. Random-effects meta-analysis was performed when ≥2 independent cohorts reported comparable estimates. Fifty-nine studies met the inclusion criteria. Baseline tricuspid regurgitation severity (OR: 2.50; 95% CI: 1.33-4.71), nonanteroseptal jet location (OR: 2.46; 95% CI: 1.08-5.60), and increasing coaptation gap (HR: 1.19 per mm; 95% CI: 1.07-1.33) predicted residual tricuspid regurgitation. Residual tricuspid regurgitation ≥3+ was the only predictor suitable for pooled synthesis across endpoints and was associated with all-cause mortality (HR: 2.19; 95% CI: 1.60-3.00) and major adverse cardiovascular events (HR: 1.84; 95% CI: 1.37-2.48) (I2 = 0%-2%.) Renal dysfunction, impaired right ventricular function and remodeling, pulmonary hypertension, and right ventricular-pulmonary arterial uncoupling reflect advanced disease substrate and demonstrated consistent associations with adverse outcomes. Among surgical risk models, the European System for Cardiac Operative Risk Evaluation II score showed limited discrimination, whereas the TRI-SCORE performed better; tricuspid transcatheter edge-to-edge repair-specific clinical models remain limited, and validated procedural prediction models are emerging. Limited data suggest that an intermediate disease profile may derive the greatest benefit, but this finding is confined to single-registry analyses. Further work is required to define optimal disease-stage thresholds and develop integrated risk models incorporating procedural outcome predictors.
- Surgical vs Transcatheter· Medicina (Kaunas, Lithuania)Prognostic Impact of Baseline Albumin-Bilirubin Score on Mortality After Transcatheter Edge-to-Edge Mitral Repair.
- Surgical vs Transcatheter· Medicina (Kaunas, Lithuania)Valve-in-Valve TAVR in Surgical Stentless Aortic Bioprostheses, a Challenging Scenario.
- Surgical vs Transcatheter· Medicina (Kaunas, Lithuania)Categories of Aortic Stenosis: What's New and the Clinical Implications.
- Aortic Valve (TAVR/TAVI)· Giornale italiano di cardiologia (2006)[Ventricular tachycardia and left bundle branch block after transcatheter aortic valve implantation: is the valve guilty forever or not?].
- Aortic Valve (TAVR/TAVI)· American heart journal plus : cardiology research and practiceClinical outcomes following transcatheter aortic valve replacement in patients with concordant versus discordant aortic stenosis.
- Aortic Valve (TAVR/TAVI)· CureusAssociation of Comorbidity Burden With In-Hospital Mortality in Transcatheter Aortic Valve Replacement Patients With Coexisting Malignancy in the United States: A Retrospective Cohort Study.