Tricuspid transcatheter edge-to-edge repair versus transcatheter tricuspid valve replacement – what are the key issues?

PURPOSE OF REVIEW: Recent clinical studies of tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) have provided important insights into patient selection and therapeutic decision-making. This review summarizes the latest evidence and proposes a practical approach to selecting the optimal transcatheter therapy. RECENT FINDINGS: The therapeutic goal of T-TEER is to achieve mild or less residual tricuspid regurgitation (TR), which is associated with favorable clinical outcomes. The likelihood of achieving this goal depends largely on tricuspid valve anatomy and transesophageal echocardiographic imaging quality. Although T-TEER has an excellent safety profile, its efficacy is limited in patients with unfavorable anatomy. In contrast, TTVR reliably achieves near-complete TR elimination and is an attractive option for patients unsuitable for T-TEER. Appropriate candidates for TTVR should have acceptable anatomical suitability, preserved right ventricular function and pulmonary hemodynamics to tolerate the acute increase in right ventricular afterload, tolerance of long-term anticoagulation, and an acceptable risk of permanent pacemaker implantation. SUMMARY: Selection between T-TEER and TTVR should be individualized, choosing the therapy that provides the optimal balance of efficacy and safety for each patient.