LAUSR

Introduction: Clinically significant tricuspid regurgitation is common especially in patients with structural heart disease and is independently associated with poor outcomes. Several transcatheter interventions for tricuspid valve repair are under investigation. We aimed to illustrate and summarize the efficacy and safety of these interventions. Methods: We conducted a literature search for relevant clinical registries and trials published until April 2020. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL. We performed the analysis of continuous outcomes using the mean difference (MD) while used the risk ratio (RR) for analysis of dichotomous outcomes. We included the following outcomes: Tricuspid annular plane systolic excursion (TAPSE), Vena Contracta (VC), Tricuspid Annulus diameter (TAD), Tricuspid regurgitation volume (TRV), Left ventricular ejection fraction (LVEF), and mortality rates. The random-effects model was used for the analysis of heterogeneous data, while homogeneous data were analyzed under the fixed-effects model. Results: We obtained fifteen clinical registries/trials and included a total of 1329 patients. We found that tricuspid valve interventional devices improved LVEF (MD = 1.46%, 95% CI [0.45, 2.47], p=0.005), led to smaller VC (MD = -4.69, 95% CI [-5.50, -3.88], p=0.005), lower TRV (MD = -11.68, 95% CI [-21.25, -2.11], p=0.02), and smaller TAD (MD = -3.78mm, 95% CI [-5.09, -2.47], p<0.001). No significant difference was noted regarding TAPSE (MD=0.07mm, 95% CI [-0.29, 0.44], p=0.7). Results of the six minutes walking test showed that patients could walk 40 more meters after intervention (MD = 40.64, 95% CI [23.89, 57.40], p<0.001). Pooled mortality rate was 8.2%, stroke 1%, and bleeding 5% during the mean 12 months follow up. Conclusions: Transcatheter tricuspid valve repair devices prove to be effective interventions in decreasing regurgitation and improving functional capacity in patients with clinically significant TR. Mortality (8% during mean 12 months follow up) seems to be related to underlying cardiovascular disease.