Tricuspid Transcatheter Edge-to-Edge Repair in Patients With Transvalvular Cardiac Implantable Electronic Device Leads: A Systematic Review and Meta-Analysis.
Lorenzo Moscato, Francesco Stabile, Giuseppe Vadalà et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared tricuspid transcatheter edge-to-edge repair (T-TEER) outcomes in patients with and without transvalvular cardiac implantable electronic device (CIED) leads. Eight observational studies included 2,779 patients, 820 (29.5%) with leads. Procedural success, early safety, functional status at 30 days, and residual tricuspid regurgitation at 1 year were similar between groups. However, 1-year all-cause mortality was higher among patients with CIEDs (RR 1.33, 95% CI 1.03 to 1.72), despite comparable valve-level outcomes.
Key findings
- Procedural success was comparable with and without transvalvular CIED leads (RR 1, 95% CI 0.95 to 1.04).
- Early safety outcomes and functional status at 30 days did not differ significantly between groups.
- At 1 year, residual TR ≤2+ was similar (RR 0.95, 95% CI 0.88 to 1.02).
- All-cause mortality at 1 year was higher in patients with CIEDs (RR 1.33, 95% CI 1.03 to 1.72).
Why it matters
The findings suggest that transvalvular leads do not necessarily prevent procedural success or comparable tricuspid regurgitation reduction with T-TEER. The higher observed mortality in patients with CIEDs, despite similar valve outcomes, highlights that technical success may not translate into equivalent patient-level outcomes and that these outcomes should be considered separately.
What to keep in mind
The evidence came from eight observational studies, so differences in patient characteristics or other factors may contribute to the mortality association; the findings do not establish that CIED leads cause higher mortality.