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Tricuspid valve regurgitation — Clinical Guidelines

Overview

Tricuspid valve regurgitation (TR) is a condition characterized by the backflow of blood from the right ventricle into the right atrium, often associated with poor prognosis, particularly in elderly patients with comorbidities 1.

Diagnosis

Clinical Symptoms: Dyspnea, fatigue, peripheral edema 1.

Echocardiography: Essential for grading severity (mild, moderate, severe) and assessing etiology (functional vs. structural) 1 5.

Cardiac Catheterization: May be used for hemodynamic assessment in complex cases 1.

Management

First-Line Treatment: Optimal medical therapy (OMT) including diuretics, ACE inhibitors/ARBs, and management of comorbidities 1 2.

Transcatheter Interventions:

- Transcatheter Edge-to-Edge Repair (TEER) and Tricuspid Valve Replacement (TTVR): Considered for high-risk surgical candidates 1 2. - Evidence: TTVI significantly reduces all-cause mortality compared to OMT at 1 year (HR 0.54, 95% CI: 0.39-0.74) 2.

Surgical Options: Tricuspid annuloplasty, particularly three-dimensional ring annuloplasty, effective in reducing TR severity 5.

Special Populations

Elderly Patients: High prevalence and often considered for transcatheter interventions due to surgical risk 1.

Comorbidities: Management tailored to underlying conditions, with a focus on reducing TR-related symptoms and improving quality of life 1 3.

Key Recommendations

Consider Transcatheter Tricuspid Valve Intervention (TTVI) for Severe Symptomatic TR in High-Risk Surgical Patients: TTVI significantly reduces all-cause mortality compared to optimal medical therapy (OMT) (Evidence: Strong 2).

Use Echocardiography for Diagnosis and Grading of TR Severity: Essential for guiding treatment decisions (Evidence: Moderate 1 5).

Implement Optimal Medical Therapy (OMT) as First-Line Management: Includes diuretics, ACE inhibitors/ARBs, and management of comorbidities (Evidence: Moderate 1).

Evaluate Tricuspid Annuloplasty for Surgical Candidates: Three-dimensional ring annuloplasty shows efficacy in reducing TR severity (Evidence: Moderate 5).

Monitor Quality of Life (QoL) in Patients Undergoing Tricuspid Repair: TEER improves QoL more than medical therapy at 1 year (Evidence: Moderate 3).

References

1 Tartaglia F, Gitto M, Villaschi A, Calamita G, Stefanini G, Reimers B et al.. Transcatheter therapies for tricuspid regurgitation: A meta-analysis of randomized trials. International journal of cardiology 2025. link 2 Fu G, Zhu J, Song W, Bagaber G, Wang C, Chen J et al.. Transcatheter tricuspid valve intervention versus medical therapy for symptomatic tricuspid regurgitation: a meta-analysis of reconstructed time-to-event data. International journal of surgery (London, England) 2024. link 3 Zajarias A, Bach RG. In severe tricuspid regurgitation, tricuspid TEER improved QoL more than medical therapy at 1 y. Annals of internal medicine 2023. link 4 Hoppe H, Pavcnik D, Chuter TA, Tseng E, Kim MD, Bernat I et al.. Percutaneous technique for creation of tricuspid regurgitation in an ovine model. Journal of vascular and interventional radiology : JVIR 2007. link 5 Filsoufi F, Salzberg SP, Coutu M, Adams DH. A three-dimensional ring annuloplasty for the treatment of tricuspid regurgitation. The Annals of thoracic surgery 2006. link 6 Asch M, Liu D, Mawdsley G. Detection of implanted metallic devices by airport security. Journal of vascular and interventional radiology : JVIR 1997. link70703-6) 7 Horner SM. The proliferation of medical papers in several countries after discoveries in cardiology. International journal of cardiology 1988. link90184-2) 8 Nakano S, Kawashima Y, Hirose H, Matsuda H. An effective adjunct to tricuspid annuloplasty. The Annals of thoracic surgery 1984. link62191-1) 9 Antunes MJ, Girdwood RW. Tricuspid annuloplasty: a modified technique. The Annals of thoracic surgery 1983. link61084-3)

Tricuspid valve regurgitation