In patients with severe secondary tricuspid regurgitation (TR), tricuspid valve transcatheter edge-to-edge repair (T-TEER), compared with transcatheter tricuspid valve annuloplasty (TTVA), showed a more favorable safety profile and a more effective and durable reduction in TR, while clinical outcomes at one year were similar with both strategies, according to research published July 22 in JACC: Advances.

Investigators Jennifer von Stein, MD, et al., evaluated procedural and clinical outcomes among 111 propensity-matched pairs treated at European centers between 2017 and 2024. Patients treated with T-TEER using the PASCAL system (n=882) had a median age of 81 years, and 52% were women; those treated with TTVA using Cardioband (n=240) had a median age of 79 years, and 76% were women.

Results showed that more patients treated with T-TEER than with TTVA achieved the primary endpoints of residual TR ≤1+ (50% vs. 34%) and TR ≤2+ (88% vs. 68%; p<0.05 for all); rates of ≥2-grade TR reduction from baseline to discharge were similar.

Among secondary endpoints, the procedural complication rate was lower with T-TEER than with TTVA (5% vs. 20%; p<0.001). This included fewer access-site complications (0.9% vs. 2.7%), major bleeding events (1.1% vs. 7.2%) and cases of acute kidney injury (0.0% vs. 7.2%).

At one year, freedom from all-cause mortality or first heart failure hospitalization was similar with T-TEER and TTVA: 75% vs. 80% (p=0.408). Reintervention rates were low and comparable (1.8% vs. 2.7%; p>0.999). Additionally, no significant difference was observed in NYHA functional class improvement, with the proportion of patients in NYHA functional class ≤II increasing from 16% to 64% after T-TEER and from 14% to 63% after TTVA.

Noting that this is the largest comparison of T-TEER and TTVA for severe secondary TR to date, the authors write, "These findings highlight the importance of procedural safety and durable TR reduction, while underscoring the complexity of translating procedural success into early clinical benefit and the need for longer-term evaluation."