Background <p>Transcatheter aortic valve replacement (TAVR) is routinely performed under general anesthesia (GA) or sedation. However, there were few studies focused on the anesthesia method when transcatheter tricuspid valve replacement (TTVR) was performed. This study aimed to investigate whether TTVR procedures can be performed effectively under sedation.</p> Methods <p>We conducted a retrospective analysis of 45 patients who underwent TAVR and 56 patients who underwent TTVR at Shanghai General Hospital between August 2023 and November 2024. The primary endpoints were the incidence of hemodynamic fluctuations and the administration of vasoactive drugs during the surgical procedures. The secondary outcomes included perioperative complications. All relevant clinical data were meticulously collected and analyzed using standardized protocols.</p> Results <p>The groups did not differ in characteristics, comorbidities and cardiac function, or myocardial injury indicators. More patients in the TAVR group experienced post-induction hypotension. The duration of hypotension was significantly longer in the TAVR group. The magnitude of MAP decline and the heart rate were more considerable in the TAVR group than in the TTVR group during the operation. The dosage of vasopressor agents was higher in the TAVR group than in the TTVR group. Finally, the clinical outcomes of patients from both groups did not differ between the two groups after surgery.</p> Conclusions <p>Performing TTVR have fewer harmful effects on hemodynamic stability and a lower likelihood of sudden incidents under GA. The results suggested that sedation may be a suitable and safe anesthesia method for TTVR and is worthy of future investigation.</p> Trial registration <p>The study was registered with ChiCTR (No: ChiCTR2500099352||<a href="http://www.chictr.org.cn/">http://www.chictr.org.cn/</a>), 21 March 2025.</p>