Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

Zexuan Wu; Wengen Zhu; Wulamiding Kaisaier; Miriding Kadier; Runkai Li; Gulpari Tursun; Yugang Dong; Chen Liu; Yili Chen

doi:10.1177/20406223231158607

Periprocedural, short-term, and long-term outcomes following transcatheter tricuspid valve repair: a systemic review and meta-analysis

Ther Adv Chronic Dis. 2023 Mar 4:14:20406223231158607. doi: 10.1177/20406223231158607. eCollection 2023.

Authors

Zexuan Wu^{1

2}, Wengen Zhu^{1

2}, Wulamiding Kaisaier¹, Miriding Kadier¹, Runkai Li¹, Gulpari Tursun¹, Yugang Dong^{1

2}, Chen Liu^{3

2}, Yili Chen^{3

2}

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
² NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, P.R. China.
³ Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P.R. China.

Abstract

Background: There has been an increasing use of transcatheter tricuspid valve repair (TTVR) recently. However, the periprocedural, short-term, and long-term outcomes of TTVR remain unclear.

Objectives: To determine the clinical outcomes in patients with significant tricuspid regurgitation undergoing TTVR.

Design: Systematic review and meta-analysis.

Data source and methods: The systematic review and meta-analysis is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and EMBASE were searched for clinical trials and observational studies until March 2022. Studies reporting the incidence of clinical outcomes after TTVR were included. The clinical outcomes included periprocedural, short-term (in-hospital or within 30 days), and long-term (>6-month follow-up) outcomes. The primary outcome was all-cause mortality whereas the secondary outcomes included technical success, procedural success, cardiovascular mortality, rehospitalization for heart failure (HHF), major bleeding, and single leaflet device attachment. The incidence of these outcomes across studies was pooled by a random-effects model.

Results: A total of 21 studies with 896 patients were included. A total of 729 (81.4%) patients underwent isolated TTVR while only 167 (18.6%) patients underwent combined mitral and tricuspid valve repair. Over 80% of the patients used coaptation devices while approximately 20% used annuloplasty devices. The median follow-up duration was 365 days. Technical and procedural success was high at 93.9% and 82.1%, respectively. The pooled perioperative, short-term, and long-term all-cause mortality for patients undergoing TTVR was 1.0%, 3.3%, and 14.1%, respectively. The long-term cardiovascular mortality rate was 5.3% while the HHF rate was 21.5%. Major bleeding and single leaflet device attachment were two major complications, accounting for 14.3% and 6.4%, respectively, during long-term follow-up.

Conclusion: TTVR is associated with high procedural success and low procedural and short-term mortality. However, all-cause mortality, cardiovascular mortality, and HHF rates remain high during long-term follow-up.

Registration: PROSPERO (CRD42022310020).

Keywords: meta-analysis; outcome; transcatheter tricuspid valve repair; tricuspid regurgitation.