Tricuspid Transcatheter Edge-to-Edge Repair in Patients with Transvalvular Cardiac Implantable Electronic Device Leads: A Systematic Review and Meta-Analysis.

Abstract

Severe tricuspid regurgitation (TR) is associated with adverse outcomes, particularly in patients with cardiac implantable electronic devices (CIEDs), in whom transvalvular leads may contribute to valve dysfunction. Evidence supporting tricuspid transcatheter edge-to-edge repair (T-TEER) in this population remains limited. We performed a systematic review and meta-analysis to evaluate whether the presence of transvalvular CIED leads is associated with differences in procedural success, early safety, or mid-term outcomes after T-TEER. PubMed, Scopus, and Cochrane Library databases were systematically searched for studies comparing T-TEER outcomes in patients with and without CIEDs. Prespecified analyses focused on procedural success, early safety, functional status, residual TR, and 1-year all-cause mortality. Pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight observational studies were included, comprising 2,779 patients, of whom 820 (29.5%) had transvalvular CIED leads. Procedural success was comparable between groups (RR 1.00; 95% CI 0.95-1.04). No significant differences were observed in early safety outcomes or functional status at 30 days. At 1-year follow-up, no significant differences were observed in residual TR ≤2+ (RR 0.95; 95% CI 0.88-1.02), while all-cause mortality was higher in patients with CIEDs (RR 1.33; 95% CI 1.03-1.72). In conclusion, in this meta-analysis, T-TEER demonstrated comparable procedural success and early safety in patients with and without transvalvular CIED leads. Despite similar TR reduction at 1 year, patients with CIEDs exhibited higher mid-term mortality, suggesting a possible discordance between valve-level technical success and patient-level clinical outcomes.