Transcatheter tricuspid valve intervention versus medical therapy for symptomatic tricuspid regurgitation: a meta-analysis of reconstructed time-to-event data

Abstract

BACKGROUND: Transcatheter tricuspid valve intervention (TTVI) has demonstrated safety and efficacy in treating high-risk patients with tricuspid regurgitation (TR). The authors aimed to perform a meta-analysis based on reconstructed time-to-event data to compare the clinical benefit of TTVI with medical therapy (MED). METHODS: A systematic literature search was conducted in major databases, including PubMed, Embase, and the Cochrane Library, until 20 October 2023. All studies comparing the outcomes between TTVI and MED were included. The primary outcome was all-cause mortality. The secondary outcomes included heart failure (HF) hospitalization and the composite outcome of all-cause mortality and HF hospitalization. RESULTS: Five studies covering 3826 patients (1146 received TTVI and 2680 received MED) were identified. At 1-year follow-up, TTVI significantly reduced the risk of all-cause mortality compared with MED [hazard ratio (HR) 0.54, 95% CI: 0.39-0.74, P=0.0001]. There was a trend in favor of TTVI in HF hospitalization, although without significant difference (HR 0.70, 95% CI: 0.42-1.18, P=0.18). TTVI was also associated with a decreased risk of composite outcome (HR 0.57, 95% CI: 0.38-0.86, P=0.007). Reconstructed Kaplan-Meier curves illustrated a 1-year overall survival rate of 83.1% in the TTVI group and 68.8% in the MED group. The subgroup analysis of device types yielded consistent results. CONCLUSIONS: Compared with MED, TTVI was associated with greater 1-year benefits for patients with symptomatic moderate or greater TR from the aspects of all-cause mortality and HF hospitalization.