Transcatheter tricuspid valve intervention versus medical therapy for symptomatic tricuspid regurgitation: a meta-analysis of reconstructed time-to-event data

Abstract

Background: Transcatheter tricuspid valve intervention (TTVI) has demonstrated safety and efficacy in treating high-risk patients with tricuspid regurgitation (TR). The authors aimed to perform a meta-analysis based on reconstructed time-to-event data to compare the clinical benefit of TTVI with medical therapy (MED).

Methods: A systematic literature search was conducted in major databases, including PubMed, Embase, and the Cochrane Library, until 20 October 2023. All studies comparing the outcomes between TTVI and MED were included. The primary outcome was all-cause mortality. The secondary outcomes included heart failure (HF) hospitalization and the composite outcome of all-cause mortality and HF hospitalization.

Results: Five studies covering 3826 patients (1146 received TTVI and 2680 received MED) were identified. At 1-year follow-up, TTVI significantly reduced the risk of all-cause mortality compared with MED [hazard ratio (HR) 0.54, 95% CI: 0.39-0.74, P=0.0001]. There was a trend in favor of TTVI in HF hospitalization, although without significant difference (HR 0.70, 95% CI: 0.42-1.18, P=0.18). TTVI was also associated with a decreased risk of composite outcome (HR 0.57, 95% CI: 0.38-0.86, P=0.007). Reconstructed Kaplan-Meier curves illustrated a 1-year overall survival rate of 83.1% in the TTVI group and 68.8% in the MED group. The subgroup analysis of device types yielded consistent results.

Conclusions: Compared with MED, TTVI was associated with greater 1-year benefits for patients with symptomatic moderate or greater TR from the aspects of all-cause mortality and HF hospitalization.

Figure 1

Forest plots showing the pooled 1-year outcomes for hazard ratio. (A) All-cause mortality. (B) Heart failure hospitalization. (C) The composite outcome of all-cause mortality and heart failure hospitalization. IV, inverse-variance; MED, medical therapy; TTVI, transcatheter tricuspid valve intervention.

Figure 2

(A) Reconstructed Kaplan–Meier curves of pooled individual patient data for all-cause mortality in TTVI and MED. (B) The trend of hazard ratio over time for all-cause mortality with TTVI versus MED. CI, confidence interval; HR, hazard ratio; MED, medical therapy; RMST, restricted mean survival time; TTVI, transcatheter tricuspid valve intervention.

Figure 3

(A) Reconstructed Kaplan–Meier curves of pooled individual patient data for heart failure hospitalization in TTVI and MED. (B) The trend of hazard ratio over time for heart failure hospitalization with TTVI versus MED. CI, confidence interval; HR, hazard ratio; MED, medical therapy; RMST, restricted mean survival time; TTVI, transcatheter tricuspid valve intervention.

Figure 4

(A) Reconstructed Kaplan–Meier curves of pooled individual patient data for the composite outcome of all-cause mortality and heart failure hospitalization in TTVI and MED. (B) The trend of hazard ratio over time for the composite outcome of all-cause mortality and heart failure hospitalization with TTVI versus MED. HR, hazard ratio; MED, medical therapy; RMST, restricted mean survival time; TTVI, transcatheter tricuspid valve intervention.