Tricuspid Transcatheter Edge-to-Edge Repair at a Crossroads: Prognosis-Shaping Intervention or High-Tech Palliation?

Tricuspid regurgitation (TR) has historically been undertreated despite its strong association with morbidity and mortality. Surgical correction of isolated TR is not routinely performed and has shown limited survival benefit, leaving a substantial unmet need for minimally invasive therapies. Transcatheter edge-to-edge repair (T-TEER) has emerged as a promising therapeutic option for patients with symptomatic severe or greater (≥severe) TR who are unsuitable for surgery. Recent randomized trials, including the TRILUMINATE Pivotal and the Tri-FR study, and real-world registries consistently demonstrate significant improvements in TR severity, functional status, and quality of life following T-TEER. Although benefits in hard clinical endpoints such as mortality or heart failure hospitalizations remain less conclusive, growing evidence suggests potential prognostic advantage in selected patients, particularly those with preserved or mid-range right ventricular function. Anatomical suitability, RV performance, and optimized patient selection are crucial determinants of success. As ongoing large-scale trials continue to evaluate long-term outcomes, T-TEER currently occupies a therapeutic space between palliative intervention and disease-modifying therapy, providing substantial symptom relief with the potential for broader clinical benefit. This review summarizes current evidence, patient selection strategies, and perspectives on the evolving role of T-TEER in the management of severe TR.