Comparative efficacy and safety of transcatheter edge-to-edge repair versus tricuspid valve replacement versus optimal medical therapy in moderate-to-severe tricuspid regurgitation: a network meta-analysis of randomized controlled trials.
Source: PubMed, NCBI / U.S. National Library of Medicine
Severe tricuspid regurgitation (TR) is associated with substantial morbidity and increased mortality. Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as less-invasive options for patients remaining symptomatic despite optimal medical therapy (OMT). We conducted a network meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TEER and TTVR versus OMT. Three RCTs were included after systematic search of PubMed, Embase, and ScienceDirect (inception to December 2025). A frequentist network meta-analysis (random-effects) was performed in R. A Bayesian NMA with vague priors was conducted in parallel to obtain posterior rank probabilities and SUCRA values. Relative effects were translated into absolute risk differences and number-needed-to-treat (NNT) / number-needed-to-harm (NNH) using pooled OMT baseline event rates, with 95% CIs via parametric bootstrap. The network comprised 1,050 patients (star-shaped, OMT common comparator; no direct TEER-TTVR comparison). Neither TEER (RR 0.99, 95% CI 0.56-1.76) nor TTVR (RR 0.85, 95% CI 0.51-1.41) significantly reduced all-cause mortality. Both interventions improved NYHA class ≥ 1 class (TEER RR 1.46, 95% CI 1.30-1.64, NNT 8; TTVR RR 3.28, 95% CI 2.41-4.47, NNT 2), KCCQ-OS (TEER MD + 11.00, 95% CI 7.46-14.54; TTVR MD + 17.80, 95% CI 12.78-22.82; both exceeding the 5-point MCID with ≥ 
Abstract
Severe tricuspid regurgitation (TR) is associated with substantial morbidity and increased mortality. Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as less-invasive options for patients remaining symptomatic despite optimal medical therapy (OMT). We conducted a network meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TEER and TTVR versus OMT. Three RCTs were included after systematic search of PubMed, Embase, and ScienceDirect (inception to December 2025). A frequentist network meta-analysis (random-effects) was performed in R. A Bayesian NMA with vague priors was conducted in parallel to obtain posterior rank probabilities and SUCRA values. Relative effects were translated into absolute risk differences and number-needed-to-treat (NNT) / number-needed-to-harm (NNH) using pooled OMT baseline event rates, with 95% CIs via parametric bootstrap. The network comprised 1,050 patients (star-shaped, OMT common comparator; no direct TEER-TTVR comparison). Neither TEER (RR 0.99, 95% CI 0.56-1.76) nor TTVR (RR 0.85, 95% CI 0.51-1.41) significantly reduced all-cause mortality. Both interventions improved NYHA class ≥ 1 class (TEER RR 1.46, 95% CI 1.30-1.64, NNT 8; TTVR RR 3.28, 95% CI 2.41-4.47, NNT 2), KCCQ-OS (TEER MD + 11.00, 95% CI 7.46-14.54; TTVR MD + 17.80, 95% CI 12.78-22.82; both exceeding the 5-point MCID with ≥ 95% confidence), and 6MWD (TEER MD + 17.53 m; TTVR MD + 30.90 m; neither clearly exceeding the 30-m MCID). Both increased major bleeding (TEER NNH 29; TTVR NNH 21) and new pacemaker implantation (TEER NNH 91; TTVR NNH 10). Bayesian posterior probability that TTVR was best was 100% for NYHA improvement, 99% for KCCQ-OS, and 82% for 6MWD, but only 1% for avoidance of pacemaker implantation. In patients with symptomatic moderate-to-severe TR, both TEER and TTVR plus OMT provide consistent and clinically meaningful improvements in functional status and quality of life. Longer-term trials with direct head-to-head comparisons are warranted. Not applicable. This study is a systematic review and meta-analysis of previously published randomized controlled trials.