Transcatheter Tricuspid Valve Annuloplasty vs Edge-to-Edge Repair

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BACKGROUND: Transcatheter tricuspid valve (TV) interventions are an effective treatment option for patients with severe symptomatic tricuspid regurgitation (TR). TV transcatheter edge-to-edge repair (T-TEER) and transcatheter TV annuloplasty (TTVA) represent distinct repair strategies; however, comparative data remain limited. OBJECTIVES: The objective of the study was to compare procedural and clinical outcomes after T-TEER and TTVA in patients with severe secondary TR. METHODS: Consecutive T-TEER or TTVA-treated patients (2017-2024) were included. A 1:1 propensity-score matching was performed. Endpoints included residual TR ≤ 1+/≤2+, a ≥2-grade reduction, procedural complications, symptomatic improvement, reinterventions, and the composite of all-cause mortality or first heart failure hospitalization within 1 year. RESULTS: Among 1,122 patients (882 T-TEER; 240 TTVA), 111 well-balanced matched pairs were identified. At discharge, T-TEER achieved higher rates of residual TR ≤ 1+ (50.0% vs 34.2%) and ≤2+ (87.7% vs 67.6%; all P < 0.05) compared with TTVA, whereas a ≥2-grade reduction was comparable. Procedural complications were less frequent with T-TEER (any complication: 4.5% vs 27.0% for T-TEER vs TTVA; P < 0.001). Symptomatic improvement and reintervention rates within 1 year were similar between groups. Freedom from the composite endpoint of all-cause mortality or first heart failure hospitalization at 1-year was 75.0% (95% CI: 66.8-84.1) after T-TEER and 79.8% (95% CI: 72.4-87.9) after TTVA (P = 0.408). CONCLUSIONS: In patients with severe secondary TR and sufficient clinical and anatomical overlap for matched comparison, T-TEER showed a more favorable safety profile and more effective, durable TR reduction, whereas early clinical outcomes at 1 year were comparable after adjustment for baseline differences, highlighting the need for longer-term evaluation.

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