Navigating isolated tricuspid regurgitation: A practical guide to perioperative and periprocedural management

Isolated tricuspid regurgitation (TR), often called the forgotten valve, defined as regurgitation occurring in the absence of left-sided heart disease, pulmonary hypertension (PH), or organic/congenital leaflet abnormalities, has recently emerged as a condition of growing clinical interest due to its increasing prevalence and its significant, independent association with adverse long-term cardiovascular outcomes. 1,2No institutional review board review was required for this study.The subject(s) provided written informed consent for the publication of the study data.This renewed attention reflects a paradigm shift in the understanding of TR, highlighting its historical underestimation and therefore suboptimal management.Contributing factors include the limited availability of outcome-based data and the lack of effective and timely therapeutic strategies. 2 Historically, isolated TR has been managed conservatively, primarily with diuretic therapy and routine surveillance, largely due to the high in-hospital mortality associated with surgical intervention. [3][4]4][5][6] Consequently, surgery has been typically reserved for symptomatic patients at advanced stages of disease progression. 7,8This conservative approach has recently been called into question, with growing debate over the optimal timing and modality of intervention.In this evolving context, the introduction of refined risk stratification tools 9,10 and the development of transcatheter therapies 11,12 have paved the way to more effective and earlier treatments.However, robust data from prospective studies are still needed to validate the safety and efficacy of these emerging options.This review aims to provide a comprehensive overview of the periprocedural management of isolated TR, addressing patient selection, timing of intervention, and postoperative care.It is presented as an expert narrative synthesis, based on a comprehensive, nonsystematic appraisal of current evidence and informed by multidisciplinary clinical experience to support decision making in routine practice (Figure 1). PREOPERATIVE CONSIDERATIONS Epidemiology and ClassificationAlthough often diagnosed incidentally during routine transthoracic echocardiography, isolated TR is more