Features and short-term outcomes of real-world transcatheter tricuspid valve repair vs. replacement in Asia-Pacific

Abstract

Background: Transcatheter therapies for tricuspid regurgitation (TR), including tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR), have shown promising safety and efficacy in clinical trials. However, real-world data in the Asia-Pacific (APAC) region remain limited. This descriptive study evaluates the clinical characteristics, procedural details, and 30-day outcomes of T-TEER and TTVR in patients with severe TR in the APAC region. Methods: A retrospective analysis was conducted on 174 patients with severe symptomatic TR treated between 2017 and 2025 at four centers in Hong Kong, Taiwan, and Thailand. Patients underwent T-TEER or TTVR (heterotopic or orthotopic). The primary outcome was TR reduction to ≤ moderate at 30 days. Secondary outcomes included procedural complications, adverse events, reinterventions, and symptom improvement. Results: Of the total cohort, 136 patients underwent T-TEER and 38 underwent TTVR. The TTVR group had more severe TR [median effective regurgitant orifice (ERO) area: 0.85 vs. 0.57 cm², P=0.001], a larger coaptation gap (median: 9.7 vs. 4.7 mm, P<0.001), and more posteroseptal TR origin (P<0.001). Combined mitral valve intervention was more common in the T-TEER group (50/136 vs. 1/38, P<0.001). At 30 days, TR reduction to ≤ moderate was achieved more frequently with TTVR (100.0%) compared with T-TEER (74.0%, P=0.001). Both groups showed significant symptomatic improvement, with 93.7% and 96.2% achieving New York Heart Association (NYHA) class I/II, respectively. TTVR was associated with higher inpatient major adverse events (15.8% vs. 2.2%, P=0.003), longer hospital stays (median: 15 vs. 5 days, P<0.001), and a greater decline in platelet count (−77,500/μL vs. −23,000/μL, P<0.001). Conclusions: In the APAC region, TTVR is primarily reserved for patients with unfavorable anatomy for T-TEER. Both interventions improve TR and symptoms, but TTVR carries higher procedural risks and longer hospitalization. This comparison was exploratory and hypothesis-generating. These findings emphasize regional practice patterns and the need for long-term comparative studies to optimize treatment strategies.