Efficacy and Safety of Transcatheter Tricuspid Valve Replacement in Patients With Moderate to Severe Tricuspid Regurgitation: A Systematic Review and Meta-Analysis on Clinical Outcomes and Echocardiographic Indices.

Background and Aims: Tricuspid regurgitation (TR) is a prevalent, often overlooked condition linked to significant morbidity and mortality in older adults. Due to the high risks associated with conventional surgery, transcatheter tricuspid valve replacement (TTVR) has emerged as a less invasive alternative. This systematic review and meta-analysis evaluated the clinical outcomes and echocardiographic indices of TTVR. Methods: Five databases were searched systematically, and eligible studies included patients with moderate or severe TR who underwent TTVR. Risk of bias was assessed using the ROBINS-I tool for observational studies and the JBI checklist for case series. A random-effects meta-analysis was performed to evaluate the impact of TTVR on major adverse cardiovascular events (MACE) and echocardiographic parameters. Results: Twenty-one studies with 643 patients (mean age 75.8 years, 70.76% female) reported a 94% technical success rate for TTVR (95% CI: 91-96%). 30-day mortality was 4% (95% CI: 2-6%) and 1-year mortality was 9% (95% CI: 6%-13%). Significant improvements were noted in TR severity (OR = 0.0013, 95% CI: 0.0006-0.0027, Conclusion: TTVR presents a promising treatment alternative for high-risk patients with severe TR, demonstrating high technical success, favorable clinical outcomes, and significant echocardiographic improvements. While the procedure is associated with low in-hospital and 1-year mortality, further studies are needed to evaluate long-term outcomes and optimize patient selection for this emerging therapy.