Work

Comparative Effectiveness of MitraClip, TriClip, and PASCAL Systems for Moderate-to-Severe Tricuspid Regurgitation: A Systematic Review, Meta- Analysis, and Meta-Regression

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background: Tricuspid regurgitation (TR) is associated with progressive right-sided heart failure and increased mortality.Transcatheter tricuspid valve repair (TTVr) has emerged as a less invasive alternative to surgery, yet comparative evidence across device platforms remains limited.Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines.PubMed/MEDLINE, Embase, and Cochrane Library were searched from inception to March 2026.Studies reporting echocardiographic, functional, or clinical outcomes following TTVr using MitraClip, TriClip, or PASCAL systems were included.Pooled estimates were derived using random-effects models, with devicespecific subgroup and REML-based meta-regression analyses performed to explore heterogeneity.Results: Thirty-one studies enrolling several thousand patients were included.TTVr was associated with significant reductions in TR regurgitant volume (MD -17.60 mL; 95% CI: -18.85 to -16.35), vena contracta width (MD -6.27 mm; 95% CI: -7.41 to -5.14), and EROA (MD -0.21 cm²; 95% CI: -0.24 to -0.18).The proportion of patients with TR ≥ grade 3+ post-intervention was 27.3%.Six-minute walk distance improved significantly (MD +33.85 m; 95% CI: +23.11 to +44.59), and NYHA class ≥ III/IV was markedly reduced (OR 0.04; 95% CI: 0.03-0.07).TAPSE was broadly preserved.Subgroup analyses demonstrated consistent effects across all three device platforms, with no statistically significant between-device differences for most outcomes.Conclusions: TTVr is associated with meaningful improvements in TR severity, echocardiographic parameters, and functional capacity across MitraClip, TriClip, and PASCAL systems.These findings support TTVr as an effective therapeutic option for patients with moderate-to-severe TR at high surgical risk.Adequately powered randomized trials with longterm follow-up are needed to establish comparative device efficacy and survival benefit.

Source: Cardiology and Cardiovascular Medicine

DOI: 10.26502/fccm.92920499