Advancements in transcatheter tricuspid valve repair and replacement: a state-of-the-art review with echocardiographic outcomes

Tricuspid regurgitation (TR) affects over 1.6 million individuals in the United States, with a one-year mortality rate of 36.1% and a five-year survival below 30%. Despite its prevalence being comparable to mitral regurgitation and aortic stenosis, TR remains understudied and inadequately managed. The underlying causes of TR vary, with primary TR stemming from structural abnormalities of the tricuspid valve, including damage caused by infectious endocarditis, rheumatic heart disease, congenital anomalies, or trauma, while secondary TR arises from right ventricular pressure and volume overload due to conditions such as heart failure (HF), atrial fibrillation, and pulmonary hypertension (PH). As TR progresses, it leads to higher hospitalization rates and imposes a significant healthcare burden, particularly in patients with advanced HF and PH. Medical therapy provides only symptomatic relief, while surgical intervention, carries high in-hospital mortality and complication risks. Given these challenges, transcatheter tricuspid valve interventions (TTVI) have emerged as promising alternatives, offering both transcatheter tricuspid valve repair (TTVr) and replacement (TTVR) strategies. TTVr devices such as TriClip, PASCAL, and Cardioband enhance leaflet coaptation or reduce annular dilation while preserving the native valve, resulting in lower procedural risks and faster recovery. Meanwhile, TTVR devices such as Evoque, TricValve, and LUX-Valve provide a definitive solution for patients with severe annular dilation, large coaptation gaps, or significant leaflet tethering. The growing population of underserved TR patients and the favourable outcomes of transcatheter therapies have accelerated advancements in device development and expanded treatment options. This review explores the latest advancements in TTVr and TVVR strategies, highlighting their clinical significance and echocardiographic outcomes based on recent data. Graphical Abstract