Current Evidence on Tricuspid Regurgitation Interventions in Heart Failure (JACC Heart Failure August 2025)-Article: Current Evidence on Tricuspid Regurgitation Interventions in Heart Failure

Article: Current Evidence on Tricuspid Regurgitation Interventions in Heart Failure

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The review discusses current advancements and ongoing research concerning interventions for tricuspid regurgitation (TR) in patients with heart failure (HF). Moderate to severe TR is prevalent in up to 23% of chronic HF patients and more than 50% in those with advanced symptoms, leading to poorer survival outcomes. The treatment landscape for TR is evolving with various medical and surgical options being explored.<br /><br />Medical management of HF and TR is not well-defined, and ongoing research is assessing the effectiveness of interventions on TR severity and HF outcomes. Transcatheter tricuspid valve interventions (TTVI) are becoming viable options, particularly for patients at high surgical risk, though the impact of these devices on mortality and HF hospitalization requires more study. Isolated tricuspid valve surgery (ITVS) outcomes depend on the timing and the patient's comorbidities, with early intervention potentially leading to better outcomes.<br /><br />TR can be categorized into primary and secondary types, with secondary TR further divided into atrial and ventricular types, based on associated pathologies. The presence of atrial fibrillation and cardiac implantable electronic devices (CIEDs) often contribute to TR's development. Surgical options, particularly ITVS, carry a high risk, underscoring the necessity for more studies on risk scores to optimize intervention timing.<br /><br />Recent randomized controlled trials (RCTs) like TRILUMINATE Pivotal and TRISCEND II show promising results in improving quality of life through tricuspid valve repair and replacement, although mortality benefits are yet to be conclusively demonstrated. Further research is needed to refine patient selection criteria and the timing of interventions to maximize clinical benefits.

Keywords

tricuspid regurgitation

heart failure

transcatheter tricuspid valve interventions

isolated tricuspid valve surgery

atrial fibrillation

cardiac implantable electronic devices

randomized controlled trials

TRILUMINATE Pivotal

TRISCEND II

patient selection criteria