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Background <p>A substantial proportion of patients undergoing tricuspid transcatheter edge-to-edge repair (TEER) have transvalvular cardiac implantable electronic device (CIED) leads, raising concern about leaflet grasping, residual tricuspid regurgitation (TR), and clinical outcomes.</p> Methods <p>Using PRISMA methodology, we performed a systematic review and meta-analysis of studies identified in PubMed, Scopus, Web of Science, and the Cochrane Library from inception through December 2025. We included studies comparing tricuspid TEER outcomes in adults with transvalvular CIED leads versus those without CIEDs. The primary outcome was post-TEER TR severity (grades I–V), while secondary outcomes included procedure duration, all-cause mortality and tricuspid valve reintervention. Pooled estimates were calculated using random-effects models with restricted maximum likelihood (REML).</p> Results <p>Five eligible studies (<i>n </i>= 1825; 628 with CIED, 1197 without) were included. Post-TEER TR grades I–III did not differ between groups (Grade I: RR 0.93, 95% CI 0.77–1.13; Grade II: RR 0.95, 95% CI 0.81–1.12; Grade III: RR 1.13, 95% CI 0.88–1.46). Patients with CIED leads had a higher risk of residual TR Grade IV (RR 2.02, 95% CI 1.23–3.32), while Grade V did not differ (RR 1.81, 95% CI 0.64–5.16). Procedure duration was similar (MD − 7.90&#xa0;min, 95% CI − 24.22 to 8.41), as were all-cause mortality (RR 0.97, 95% CI 0.61–1.54) and TV reintervention (RR 1.31, 95% CI 0.54–3.18).</p> Conclusions <p>In selected patients undergoing tricuspid TEER, transvalvular CIED leads do not appear to preclude meaningful TR reduction or clinical stability. However, lead-bearing anatomy may still predispose to residual Grade IV TR, supporting careful, mechanism-based Heart Team assessment for patient selection and procedural planning.</p>

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Outcomes of tricuspid transcatheter edge-to-edge repair in patients with versus without transvalvular cardiac implantable electronic device leads: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Ahmed Farid Gadelmawla,
  • Ahmed Elbataa,
  • Ahmed Mansour,
  • Khalil Saud Abojubara,
  • Ahmed Saleh Alhumaid,
  • Abdullah Faisal Albukhari,
  • Judi Sayyaf Alnfaiei,
  • Rola Ahmed Kumait,
  • Shaden Alotaibi,
  • Mohammed Aziz Alemari,
  • Khaled Jubran Khormi,
  • Abduljabbar Yassen Alrasasy,
  • Mothana Yousif Al Jabr,
  • Abdulrahman Alzaeim,
  • Ameer Awashra,
  • Khadeeja Sohail Sirajuddin

摘要

Background

A substantial proportion of patients undergoing tricuspid transcatheter edge-to-edge repair (TEER) have transvalvular cardiac implantable electronic device (CIED) leads, raising concern about leaflet grasping, residual tricuspid regurgitation (TR), and clinical outcomes.

Methods

Using PRISMA methodology, we performed a systematic review and meta-analysis of studies identified in PubMed, Scopus, Web of Science, and the Cochrane Library from inception through December 2025. We included studies comparing tricuspid TEER outcomes in adults with transvalvular CIED leads versus those without CIEDs. The primary outcome was post-TEER TR severity (grades I–V), while secondary outcomes included procedure duration, all-cause mortality and tricuspid valve reintervention. Pooled estimates were calculated using random-effects models with restricted maximum likelihood (REML).

Results

Five eligible studies (n = 1825; 628 with CIED, 1197 without) were included. Post-TEER TR grades I–III did not differ between groups (Grade I: RR 0.93, 95% CI 0.77–1.13; Grade II: RR 0.95, 95% CI 0.81–1.12; Grade III: RR 1.13, 95% CI 0.88–1.46). Patients with CIED leads had a higher risk of residual TR Grade IV (RR 2.02, 95% CI 1.23–3.32), while Grade V did not differ (RR 1.81, 95% CI 0.64–5.16). Procedure duration was similar (MD − 7.90 min, 95% CI − 24.22 to 8.41), as were all-cause mortality (RR 0.97, 95% CI 0.61–1.54) and TV reintervention (RR 1.31, 95% CI 0.54–3.18).

Conclusions

In selected patients undergoing tricuspid TEER, transvalvular CIED leads do not appear to preclude meaningful TR reduction or clinical stability. However, lead-bearing anatomy may still predispose to residual Grade IV TR, supporting careful, mechanism-based Heart Team assessment for patient selection and procedural planning.