Contemporary Evaluation and Management Strategies for Tricuspid Regurgitation

Background: Tricuspid regurgitation (TR) is a common but historically under-recognized valvular heart disease. Although mild to moderate TR was long considered benign, accumulating evidence indicates that clinically significant TR is associated with right ventricular failure, hepatic congestion, recurrent hospitalization, and increased mortality. Aims: This review aims to provide a comprehensive overview of contemporary evaluation and management strategies for TR across its clinically relevant spectrum, with particular emphasis on severe disease and secondary mechanisms when discussing intervention. Methods: Current literature was synthesized with a focus on TR classification, underlying mechanisms, imaging and hemodynamic assessment, risk stratification, device-related TR, and evolving therapeutic strategies, including both surgical and transcatheter approaches. Results: Management paradigms have shifted toward earlier recognition and intervention, with echocardiography remaining central to diagnosis and procedural planning. While medical therapy is primarily supportive, advances in transcatheter edge-to-edge repair, annuloplasty systems, and transcatheter valve replacement have significantly expanded treatment options, particularly for patients at high surgical risk. Key determinants of therapeutic decision-making include pulmonary artery pressure, right ventricle–pulmonary artery coupling, right-sided chamber remodeling, surgical risk, and anatomic suitability. Conclusion: TR represents a complex and rapidly evolving area of cardiology that requires individualized assessment based on anatomy, hemodynamics, comorbidities, and the quality of available evidence. Ongoing clinical trials and emerging therapies are expected to further refine treatment algorithms and future guideline recommendations.