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Key Points: Question: Does tricuspid transcatheter edge-to-edge repair (T-TEER) combined with optimized medical therapy (OMT) improve patient-reported outcome measures and clinical outcomes compared with OMT alone in patients with severe, symptomatic tricuspid regurgitation? Findings: In a prospective, randomized (1:1) trial involving 300 patients with severe, symptomatic tricuspid regurgitation, treatment with T-TEER plus OMT vs OMT alone improved a composite score comprising patient-reported outcome measures and clinical events at 1 year. Meaning: The addition of T-TEER to OMT reduces severity of tricuspid regurgitation and improves a composite outcomes score, driven by improved patient-reported outcome measures, in patients with severe, symptomatic tricuspid regurgitation. Importance: Correction of tricuspid regurgitation using tricuspid transcatheter edge-to-edge repair (T-TEER) in addition to guideline-directed optimized medical therapy (OMT) may improve clinical outcomes. Objective: To evaluate the efficacy of T-TEER + OMT vs OMT alone in patients with severe, symptomatic tricuspid regurgitation. Design, Setting, and Participants: Investigator-initiated, prospective, randomized (1:1) trial evaluating T-TEER + OMT vs OMT alone in adult patients with severe, symptomatic tricuspid regurgitation. The trial was conducted at 24 centers in France and Belgium (March 2021 to March 2023; latest follow-up in April 2024). Intervention: Patients were randomized to T-TEER + OMT or OMT alone. Main Outcomes and Measures: The primary outcome was a composite clinical end point at 1 year comprising change in New York Heart Association class, change in patient global assessment, or occurrence of major cardiovascular events. Tricuspid regurgitation severity was the first of 6 secondary outcomes analyzed in a hierarchical closed-testing procedure, including Kansas City Cardiomyopathy Questionnaire (KCCQ) score, patient global assessment, and a composite outcome of all-cause death, tricuspid valve surgery, KCCQ score improvement, or time to hospitalization for heart failure. Results: Of 300 enrolled patients (mean age, 78 [SD, 6] years, 63.7% women), 152 were allocated to T-TEER + OMT and 148 to OMT alone. At 1 year, 109 patients (74.1%) in the T-TEER + OMT group had an improved composite score compared with 58 patients (40.6%) in the OMT-alone group. Massive or torrential tricuspid regurgitation was found in 6.8% of patients in the T-TEER + OMT group and in 53.5% of those in the OMT-alone group (P <.001). Mean overall KCCQ summary score at 1 year was 69.9 (SD, 25.5) for the T-TEER + OMT group and 55.4 (SD, 28.8) for the OMT-alone group (P <.001). The win ratio for the composite secondary outcome was 2.06 (95% CI, 1.38-3.08) (P <.001). Conclusions and Relevance: T-TEER reduces tricuspid regurgitation severity and improves a composite score driven by improved patient-reported outcome measures in patients with severe, symptomatic tricuspid regurgitation. Trial Registration: ClinicalTrials.gov Identifier: NCT04646811 This randomized clinical trial evaluates the efficacy of tricuspid transcatheter edge-to-edge repair plus guideline-directed optimized medical therapy (OMT) vs OMT alone for improving clinical outcomes in adult patients in with severe, symptomatic tricuspid regurgitation in France and Belgium. [ABSTRACT FROM AUTHOR]