Clinical Outcomes and Patient Selection for Transcatheter Tricuspid Edge-to-Edge Repair (TEER) Versus Transcatheter Tricuspid Valve Replacement (TTVR)

Abstract

Tricuspid regurgitation (TR) is common, undertreated, and associated with substantial morbidity and mortality. Transcatheter tricuspid valve intervention (TTVI), comprising transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR), has emerged as an alternative to surgery. In this narrative review, we summarize device design and implantation techniques (TriClip, PASCAL, Cardioband, EVOQUE), evidence from pivotal and early feasibility trials (TRILUMINATE, CLASP TR, TRI-REPAIR, TRISCEND II), and the anatomic and clinical factors that guide patient selection. TEER and annuloplasty reduce TR and improve symptoms and quality of life, with lower rates of bleeding and conduction disturbance than TTVR. TTVR with EVOQUE achieved more complete TR reduction (99.1% with moderate or less TR) but carried higher rates of bleeding and new pacemaker implantation. Differences in trial design and study populations preclude direct comparison. Coaptation gap, jet location, leaflet tethering, annular size, device leads, and right ventricular function determine device suitability. TTVI is an effective treatment for TR, but long-term durability and conduction-system safety remain uncertain. We propose a heart team algorithm to guide selection between TEER and TTVR.