Transcatheter tricuspid valve replacement for severe tricuspid regurgitation: current and future perspectives

INTRODUCTION: Severe tricuspid regurgitation (TR) is common, undertreated, and associated with significant morbidity and mortality. Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising option for patients unsuitable for surgical repair or transcatheter edge-to-edge repair. AREAS COVERED: This review examines the innovation trajectory, current device landscape, patient selection, imaging guidance, procedure-specific challenges, and future perspectives of TTVR. A systematic literature search was performed using PubMed/MEDLINE, Embase, and ClinicalTrials.gov, covering publications from January 2015 to May 2025, using search terms including 'transcatheter tricuspid valve replacement,' 'TTVR,' 'tricuspid regurgitation,' and device-specific names. EXPERT OPINION: TTVR offers near-complete regurgitation elimination but remains anatomy- and mechanism-dependent. Its role is best defined in patients with anatomy unfavorable for repair. Optimal timing, device selection, antithrombotic management, and long-term durability require prospective validation through dedicated trials and head-to-head comparisons with repair strategies.