Transcatheter tricuspid valve intervention versus optimal medical therapy alone for severe tricuspid regurgitation: an updated meta-analysis with reconstructed time-to-event data
IJC Heart and Vasculature, cilt.61, 2025 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 61
- Basım Tarihi: 2025
- Doi Numarası: 10.1016/j.ijcha.2025.101794
- Dergi Adı: IJC Heart and Vasculature
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, Directory of Open Access Journals
- Anahtar Kelimeler: All-cause mortality, Heart failure hospitalization, Meta-analysis, Optimal medical therapy, Severe tricuspid regurgitation, Transcatheter tricuspid valve intervention
- Ankara Yıldırım Beyazıt Üniversitesi Adresli: Evet
Özet
Background: Severe tricuspid regurgitation (TR) is strongly associated with high mortality and morbidity. This meta-analysis aims to compare the outcomes of transcatheter tricuspid valve intervention (TTVI) versus optimal medical treatment (OMT) alone among patients with severe TR. Methods: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched observational studies comparing TTVI with OMT. The primary outcome was all-cause mortality. Summary estimates were calculated using a random-effects model. Results: Five studies (3 RCTs, 2 observational; n = 1988 patients) were included. TTVI was associated with a nonsignificant trend toward a lower incidence of all-cause mortality (risk ratio [RR]: 0.70, 95 % confidence interval [CI] 0.48–1.03; P = 0.071), primarily driven by observational studies. TTVI demonstrated significant benefits in terms of TR severity reduction (RR: 7.82, 95 % CI 5.60–10.93; P < 0.0001), enhanced health status as measured by the Kansas City Cardiomyopathy Questionnaire (mean difference: +14.46 points, 95 % CI 11.55–17.38; p < 0.0001), and reduced heart failure (HF) hospitalization rates (RR: 0.73, 95 % CI 0.56–0.96; P = 0.025). However, TTVI was associated with an increased risk of major bleeding (RR: 3.21, 95 % CI 1.61–6.39; P = 0.0009). Conclusion: Among patients with severe TR, TTVI was not statistically associated with a lower incidence of all-cause mortality but was associated with a reduced risk of HF hospitalization, significant reduction in TR severity, and improved quality of life. Future large RCTs with extended follow-up are needed to confirm these findings and identify the subset of patients who benefit the most. Systematic review protocol: CRD420251002402 (PROSPERO)