Dear Editor,
We are interested in the article entitled “Transcatheter tricuspid valve intervention versus medical therapy for symptomatic tricuspid regurgitation: a meta-analysis of reconstructed time-to-event data” authored by Fu et al[1], published in the International Journal of Surgery. We appreciate and congratulate the research work conducted by the Fu et al team. Artificial intelligence (AI) is increasingly being used in research and the development of the scholarly literature. This draft was revised using AI after the manuscript was completed to check the spelling, grammar and syntax to ensure that the language was concise. We ensure our article is compliant with the TITAN Guidelines 2025[2], show in TITAN Guideline Checklist 2025.
Transcatheter tricuspid valve intervention (TTVI) has demonstrated safety and efficacy in treating high-risk patients with tricuspid regurgitation (TR).The authors aimed to perform a meta-analysis based on reconstructed time-to-event data to compare the clinical benefit of TTVI with medical therapy (MED).The researchers included five studies covering 3826 patients (1146 received TTVI and 2680 received MED).The study concluded that at 1-year follow-up, TTVI significantly reduced the risk of all-cause mortality and heart failure (HF) hospitalization in symptomatic moderate or severe TR patients compared with MED.
We acknowledge the validity of these findings, but after careful reading of the article, we believe that the following points need to be further discussed and demonstrated.
Firstly, for symptomatic moderate or severe TR patients, there are different indications for TTVI and MED. About the conclusion of this study, we think it is need to further discuss and verify. This meta-analysis only included five studies, there might be patient’s factors such as economic reasons or physical condition that led to the choice of MED instead of TTVI. Patients who received TTVI may have better cardiac function compared to those treated with medication, resulting in lower all-cause mortality and HF hospitalization. Therefore, it cannot be generalized.
Secondly, studies have reported that TTVI can improve symptoms and quality of life in patients with severe TR, but the prognostic benefits remain uncertain[3,4]. Moreover, the choice and timing of TTVI patients are still unclear, early identification of tricuspid regurgitation patients may improve outcomes in patients treated with TTVI. There are other studies have reported a reduced risk of death with TTVI in patients with 2 or 3 right heart failure (RHF) criteria, but no association with mortality with TTVI in patients with no or 1 RHF criterion[5]. It is unclear whether TTVI becomes ineffective in advanced RHF.
Thirdly, if patients treated with TTVI have RHF postoperative, they will also take drugs to correct it. There may be differences in baseline characteristics compared with patients who are given only medical therapy.
Fourthly, the differences baseline characteristics of patients, surgical techniques of surgeons, and medication regimen among these five studies were not mentioned. It might affect the results of the meta-analysis. It is recommended to conduct heterogeneity analysis or use random effects model to deal with the heterogeneity among studies.
Finally, the studies included only followed up for 1 year, which is a relatively short.TR patients treated with TTVI or MED usually require long-term management, so a longer follow-up time may provide more comprehensive clinical outcomes.
Future studies to explore the clinical efficacy of TTVI and MED in the treatment of patients with TR should take into account the different levels of cardiac functional grading and basic physical status of patients, and provide appropriate treatment for patients.
In conclusion, solving these problems will improve the reliability of research results.
Footnotes
Yanyan Song, Bo Jiang, and Xudong Liu contributed equally to this study.
Published online 5 June 2025
Contributor Information
Yanyan Song, Email: nxfysyy@163.com.
Bo Jiang, Email: jiangbolml@163.com.
Xudong Liu, Email: xudong669@163.com.
Ethical approval
Our submitted manuscript does not involve any patients without the ethical approval document.
Consent
Not applicable.
Sources of funding
None.
Author contributions
Y.S. participated in the original idea, writing the first draft, and editing the final manuscript. The author also approved the last version of this manuscript.
Conflicts of interest disclosure
None.
Guarantor
Yanyan Song.
Research registration unique identifying number (UIN)
Not applicable.
Provenance and peer review
Not applicable.
Data availability statement
Not applicable.
Assistance with the study
None.
References
- [1].Fu G, Zhu J, Song W, et al. Transcatheter tricuspid valve intervention versus medical therapy for symptomatic tricuspid regurgitation: a meta-analysis of reconstructed time-to-event data. Int J Surg 2024;110:6800–09. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Associated Data
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Data Availability Statement
Not applicable.