Tricuspid Regurgitation: When and How to Treat

Clinically significant tricuspid regurgitation (TR) is increasingly prevalent in the aging population. TR is a progressive disease associated with worse outcomes, and therefore should be treated appropriately and in a timely manner. This review will summarize the indications for treatment of TR, and the invasive modalities currently available or under development for the management of TR. Despite its association with increased morbidity and mortality, surgery for isolated TR is uncommon due to increased operative risk. Various transcatheter tricuspid valve (TV) therapies have been developed as an alternative to surgery to address this unmet clinical need. Transcatheter TV repair devices improve leaflet coaptation either directly by bringing the leaflets together (coaptation devices) or indirectly by repairing the dilated tricuspid annulus (annuloplasty devices), whereas orthotopic transcatheter TV replacement involves implantation of a prosthesis in the tricuspid position. Recent first-in-man and phase 1/2 clinical investigations have demonstrated high procedural success rates with reasonable safety and efficacy. Transcatheter TV therapies may offer a less invasive and potentially safer alternative to surgery for the management of severe symptomatic TR. Ongoing studies will shed light on long-term outcomes and device durability, and inform patient selection and optimal timing of intervention.