A Contemporary Look at the Landscape of Treatment of Tricuspid Regurgitation: A Review

Abstract

Importance: Untreated severe tricuspid regurgitation carries a poor prognosis. We aim to provide a contemporary review of the anatomy, clinical manifestations, and diagnostic and management strategies, including medical, surgical and transcatheter options. By synthesizing current knowledge, this review seeks to equip clinicians with the insights necessary to navigate the complexities of TR treatment.

Observations: Tricuspid regurgitation is predominantly secondary to annular dilation and leaflet tethering but can also be associated with cardiac implantable electronic device leads and primary leaflet pathologies. Isolated tricuspid valve surgery is infrequently performed, especially in high surgical risk patients, prompting the emergence of transcatheter treatment options. These advancements are complemented by significant strides in multimodality imaging, including three-dimensional echocardiography, computed tomography, and magnetic resonance imaging, which enhance diagnostic accuracy and procedural planning.

Conclusions and relevance: The effective management of tricuspid regurgitation necessitates a multidisciplinary approach, integrating input from interventional cardiology, cardiac surgery, heart failure cardiology, imaging, and electrophysiology. Surgical and transcatheter interventions such as tricuspid transcatheter-edge-to-edge repair and transcatheter tricuspid valve replacement have demonstrated favorable early clinical and functional outcomes, but ongoing research is necessary to refine patient selection and improve treatment decision-making. Individualizing treatment plans to optimize health outcomes and quality of life for patients with tricuspid regurgitation is paramount.