Exploration of Anesthetic Strategies for Transcatheter Tricuspid Valve Intervention

Tricuspid regurgitation (TR) is a critical factor in the progression of right heart failure. Although conventional open surgery remains the definitive treatment, the application of this technique is significantly limited in older and high-risk patients due to frequent comorbidities, including impaired right ventricular functional reserve, pulmonary hypertension, and multi-organ dysfunction, which lead to substantially increased surgical risks. Transcatheter tricuspid valve intervention (TTVI), which achieves anatomical correction through minimally invasive approaches, has emerged as an effective alternative strategy for patients deemed ineligible for surgery. During these procedures, anesthesiologists face three core challenges: susceptibility to acute changes in the preload of the right ventricle, a high risk of circulatory collapse (particularly in functional TR with right ventricular decompensation), and the precise integration of intraoperative transesophageal echocardiography (TEE) with hemodynamic monitoring. Consequently, anesthesiologists who become experts in the pathological staging of TR, key points of image-guided device implantation, and warning indicators of circulatory collapse can help maintain perioperative stability. Moreover, gaining a thorough understanding of the pathological progression of tricuspid valve disease, improving the assessment of right heart function, and optimizing the TTVI process and management capabilities are crucial for improving patient outcomes. Thus, establishing a perioperative anesthetic strategy focused on right heart protection may reduce cardiovascular-related complications and all-cause mortality.