Tricuspid regurgitation after heart transplantation: where innovation and intervention are in hibernation

Tricuspid regurgitation (TR) is a common valvular dysfunction following heart transplantation (HT), with reported prevalence rates ranging from 19 to 84%, primarily depending on the duration of follow-up. Its etiology is multifactorial and includes surgical technique, ischemic time, primary graft dysfunction, pulmonary hypertension, pacemaker leads, and endomyocardial biopsies. Severe TR can significantly impair graft function, exercise capacity, and patient survival. This mini-review explores current management strategies, including surgical techniques such as annuloplasty and tricuspid valve replacement. HT patients are often high-risk surgical candidates due to factors such as immunosuppressive therapy, prior surgeries, and various comorbidities. Therefore, we primarily focus on the evidence regarding emerging interventional methods, such as transcatheter edge-to-edge repair. Although these interventions show promising early results, they remain relatively novel in HT recipients, and the current evidence is based on case reports and small studies. Further research is essential to evaluate the long-term efficacy and safety of these management strategies to enhance outcomes for HT recipients with TR.