When surgery is not an option: is there a clinical need for transcatheter tricuspid valve therapies?

: Severe functional tricuspid regurgitation (FTR) is frequent and carries a poor prognosis when left untreated. The strategy in symptomatic patients should be decided by a Heart Team who will choose between valve surgery, transcatheter intervention, heart transplantation or palliative medical therapy. The field of application of transcatheter tricuspid valve therapy will certainly focus on inoperable or high-risk patients first, especially those with FTR occurring late after left-sided valve surgery. If surgery is contraindicated because of multiple comorbidities interventions which are likely to be "futile" should be avoided. Conversely, if life expectancy is acceptable, it is attractive to envisage percutaneous intervention. Thus, there is a clinical need for transcatheter tricuspid valve therapies when surgery is not an option. Controlled clinical studies are necessary to show the safety profile and the performance of the new transcatheter procedures and define their potential role.