Transcatheter therapies are expanding options for severe tricuspid regurgitation (TR), but comparative real-world data remain limited in the Asia-Pacific region. A retrospective multicenter analysis published in Annals of Cardiothoracic Surgery evaluated 30-day outcomes of transcatheter tricuspid valve replacement (TTVR) and tricuspid transcatheter edge-to-edge repair (T-TEER).

The study included 174 patients with severe symptomatic TR treated between 2017 and 2025 across four centers in Hong Kong, Taiwan, and Thailand. Of these, 136 underwent T-TEER, and 38 received TTVR using heterotopic or orthotopic approaches.

Baseline anatomy was more complex in the TTVR group, including a larger effective regurgitant orifice (ERO) area (0.85 vs 0.57 cm²; P = 0.001), a wider coaptation gap (9.7 vs 4.7 mm; P < 0.001), and a more frequent posteroseptal TR origin. Combined mitral valve intervention was more common with T-TEER (50/136 vs 1/38; P < 0.001).

At 30 days, TR reduction to moderate or less occurred more often with TTVR than T-TEER (100.0% vs 74.0%; P = 0.001). Both groups had marked symptomatic improvement, with New York Heart Association (NYHA) class I/II reached in 93.7% and 96.2%, respectively.

TTVR was also associated with higher inpatient major adverse events (15.8% vs 2.2%; P = 0.003), longer median hospital stay (15 vs 5 days; P < 0.001), and greater platelet count decline (−77,500/µL vs −23,000/µL; P < 0.001). 

These findings suggest TTVR was mainly selected for anatomically challenging TR cases in APAC practice. Both therapies improved TR and symptoms, but TTVR was associated with a higher short-term risk and longer hospitalization. Longer-term comparative studies are warranted.