Tricuspid Valve Transcatheter Edge-to-Edge Repair in Patients With Cardiac Implantable Electronic Devices

Background: Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is increasingly used in patients with severe tricuspid regurgitation (TR) at high surgical risk. Long-term outcomes in those with transvalvular cardiac implantable electronic devices (CIEDs) remain insufficiently characterized. Objectives: The aim of this study was to evaluate procedural and clinical outcomes of T-TEER in patients with CIED leads in a real-world cohort. Methods: Among 3,025 patients undergoing T-TEER at 26 centers (2016-2024), 851 (28.1%) had transvalvular CIED leads. Residual TR at discharge and follow-up and the composite of all-cause mortality or heart failure hospitalization at 2 years were assessed. CIED function was evaluated pre- and postprocedure. Propensity score matching (1:1) was conducted to compare outcomes between patients with and those without CIEDs. Results: CIED function remained stable, and no lead revision was required. At discharge, TR ≤1+ and ≤2+ was achieved in 39.9% and 79.8%, respectively; at follow-up (median 269 days; Q1-Q3: 63-423 days), TR ≤1+ and ≤2+ persisted in 29.3% and 69.1%. In 385 matched pairs, residual TR, functional status, and 2-year heart failure hospitalization-free survival were comparable between patients with and those without CIEDs (67.1% [95% CI: 62.1%-72.5%] vs 73.6% [95% CI: 68.9%-78.6%]; P = 0.176). CIED presence showed a nonsignificant association with more adverse outcomes (HR: 1.31; 95% CI: 0.99-1.74; P = 0.063) but was not associated with residual TR >2+ (OR: 0.98; 95% CI: 0.70-1.38; P = 0.915). Achieving residual TR ≤2+ conferred significantly better survival irrespective of CIED presence (P < 0.001). Conclusions: T-TEER is safe and effective in selected patients with transvalvular CIED leads. Effective TR reduction remains prognostically relevant, even in this high-risk real-world population.