Transcatheter edge-to-edge repair in functional tricuspid regurgitation

Tricuspid edge-to-edge repair (T-TEER) has emerged as a promising treatment option for severe functional tricuspid regurgitation (TR) in patients unsuitable for surgery. Recent findings from randomized clinical trials consistently demonstrated a reduction in TR severity and significant symptomatic improvement with T-TEER, particularly in terms of quality of life and functional status. However, no significant differences in mortality or hospitalizations were observed compared to guideline-directed medical therapy. In this complex scenario, careful patient selection and a comprehensive evaluation of the tricuspid valve remain critical for optimizing outcomes. Patients with preserved right ventricular (RV) function, absence of pulmonary hypertension (PH), and no significant organ dysfunction are more likely to benefit from T-TEER. Conversely, in patients with severe RV dysfunction, lack of contractile reserve, pre-capillary or severe combined post-capillary PH, end-stage organ failure, and significant impairment in daily activities and self-care, the procedure may be futile. Patients in the grey zone should be evaluated by a dedicated heart team, with a tailored decision-making approach.