Transcatheter Tricuspid Valve Intervention Versus Optimal Medical Therapy in Symptomatic Tricuspid Regurgitation: A Systematic Review and Meta-Analysis of Randomized and Observational Studies.

Severe symptomatic tricuspid regurgitation is associated with a poor prognosis, and many patients are ineligible for surgical intervention. Transcatheter tricuspid valve intervention (TTVI) has emerged as a less invasive alternative, but its impact on clinical outcomes compared with optimal medical therapy (OMT) remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing TTVI (transcatheter edge-to-edge repair or valve replacement) with OMT. Databases were searched from inception through December 31, 2025. Outcomes included all-cause and cardiovascular mortality, heart failure hospitalization, myocardial infarction, stroke, bleeding, and new permanent pacemaker or implantable cardioverter-defibrillator implantation. Random-effects models were used to calculate pooled odds ratios. Thirteen studies encompassing 6,732 patients (3,240 TTVI; 3,492 OMT) were included. In pooled analyses of randomized and observational studies, TTVI was associated with a significant reduction in all-cause mortality compared with OMT (odds ratios 0.70; p = 0.009). However, this benefit was not observed in an RCT-only analysis. No significant differences were noted in cardiovascular mortality, heart failure hospitalization, myocardial infarction, severe bleeding, or stroke. A nonsignificant trend toward increased permanent pacemaker/implantable cardioverter-defibrillator implantation (p = 0.06) was primarily driven by valve replacement devices. In symptomatic tricuspid regurgitation, TTVI was associated with reduced all-cause mortality in pooled analyses incorporating both randomized and observational data; however, this benefit was not confirmed in RCT-only analyses, likely reflecting residual confounding in nonrandomized studies which may overestimate treatment effects. These findings support TTVI as an effective therapeutic option for appropriately selected high-risk patients.