TEER was associated with a greater reduction in right atrial pressure and more favorable RV remodeling at 30 days, as opposed to TTVR, which achieved more complete and sustained elimination of tricuspid regurgitation with higher forward stroke volume.
Mean right atrial pressure decreased significantly after TEER but not TTVR.
V wave pressure decreased in both TEER and TTVR groups post-intervention.
RV enlargement prevalence decreased in both groups at 30 days, though the reduction was statistically significant only in the TEER group.
Prevalence of RV dysfunction showed divergent trends between groups at 30 days, decreasing in TEER and increasing in TTVR.
TTVR achieved more complete and sustained elimination of tricuspid regurgitation and higher stroke volume index compared to TEER.
Both TEER and TTVR resulted in similar improvements in NYHA functional class and overall similar survival.
TEER was associated with more favorable right ventricular remodeling at 30 days compared to TTVR.
This research suggests that two catheter-based procedures for treating a leaky tricuspid heart valve — edge-to-edge repair (TEER), which clips the valve leaflets together, and transcatheter tricuspid valve replacement (TTVR), which implants a new valve — produce different but complementary benefits. The study followed 100 patients (50 in each group) who had significant tricuspid regurgitation and compared how the heart responded immediately after each procedure and over the following year. Both groups had similar ages (around 80-81 years) and symptom severity going into treatment. The key differences found were that TEER more effectively reduced pressure in the right atrium (the chamber that fills the tricuspid valve) and was associated with more favorable changes in the size and function of the right ventricle at 30 days. In contrast, TTVR more completely eliminated the valve leak and resulted in a higher volume of blood being pumped forward with each heartbeat. Notably, right ventricular dysfunction appeared to worsen slightly in the TTVR group at 30 days (from 31% to 44%), while it trended toward improvement in the TEER group (from 26% to 15%), though neither change was statistically significant. Despite these mechanical differences, both procedures led to similar improvements in patients' reported symptoms (measured by heart failure classification) and similar survival rates over one year. This research suggests that the choice between these two procedures may depend on individual patient factors, including the degree of valve leakage that needs to be corrected and the underlying condition of the right ventricle, and that each approach offers distinct hemodynamic trade-offs that clinicians may need to weigh when selecting treatment.
Alabdaljabar M, Elhadi M, Thaden J, Padang R, Pislaru S, Hibbert B, et al.. (2026). Hemodynamic Changes After Transcatheter Valve Repair and Replacement for Tricuspid Regurgitation.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.050310