Transcatheter treatment of tricuspid regurgitation: a state of art review.

Abstract

Recent advancements in transcatheter techniques for the treatment of severe tricuspid regurgitation (TR) have introduced minimally invasive therapies with significantly lower risk profiles compared to traditional surgical approaches. Despite this progress, the latest European guidelines still recommend surgery as the "gold standard" for severe primary and secondary TR, particularly during left heart surgery or in cases with right ventricular dilation. However, surgical interventions are associated with high mortality and morbidity rates, making them less desirable for high-risk patients. As a result, transcatheter tricuspid valve interventions (TTVI) have emerged as promising alternatives, reshaping treatment paradigms. Among these, the tricuspid edge-to-edge repair (T-TEER) technique, using devices like the TriClip and PASCAL, has demonstrated significant clinical benefits, including improved valve function, symptom relief, and quality of life. While the TRI-SCORE and TRIVALVE risk scores help guide patient selection, further research is needed to refine outcomes across diverse clinical settings. Additionally, newer technologies like transcatheter valve replacement (TTVR) offer viable solutions for patients with complex anatomies. TTVR, exemplified by the EVOQUE valve, has shown promise in reducing TR and improving functional status, though it carries risks such as bleeding and pacemaker implantation. Moreover, heterotopic valve implantation, such as the TricValve, provides a less invasive option for symptom management, although it does not address the underlying valve pathology. Overall, the expanding range of transcatheter treatments is providing safer, effective alternatives for high-risk patients, with ongoing research critical to optimizing outcomes.