Current research status of transcatheter tricuspid valve intervention_West China Medical Journal

Authors：

CAO Jingyi ,  LU Fanglin

Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P. R. China;

Corresponding author：

LU Fanglin, Email: drlufanglin@yeah.net

Keywords：

Transcatheter tricuspid valve intervention; tricuspid regurgitation; intervention timing; tricuspid valve repair; tricuspid valve replacement

DOI：

10.7507/1002-0179.202509102

Video：

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Tricuspid regurgitation (TR) is a common cardiac valve disease in clinic. Traditional medical treatment can only relieve symptoms, while surgical operations, due to their large trauma and high risks, are difficult to cover high-risk patients who are elderly and with multiple comorbidities. Transcatheter tricuspid valve intervention (TTVI), as a new treatment strategy, provides a new choice for this group. In recent years, various devices for TTVI have emerged. This paper elaborates the characteristics of TR, the design characteristics of existing TTVI devices, relevant clinical research, and the comprehensive evaluation means of device selection, and points out the existing shortcomings and future development direction.

1.	Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol, 1999, 83(6): 897-902.
2.	Topilsky Y, Maltais S, Medina Inojosa J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging, 2019, 12(3): 433-442.
3.	Czapla J, Claus I, Martens T, et al. Midterm comparison between different annuloplasty techniques for functional tricuspid regurgitation. Ann Thorac Surg, 2022, 114(1): 134-141.
4.	Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg, 2012, 143(5): 1043-1049.
5.	Dhoble A, Zhao Y, Vejpongsa P, et al. National 10-year trends and outcomes of isolated and concomitant tricuspid valve surgery. J Cardiovasc Surg (Torino), 2019, 60(1): 119-127.
6.	McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-685.
7.	Litwiński P, Kołsut P, Sitko T, et al. Results and factors associated with adverse outcome after tricuspid valve replacement. Kardiol Pol, 2018, 76(4): 731-739.
8.	Taramasso M, Benfari G, van der Bijl P, et al. Transcatheter versus medical treatment of patients with symptomatic severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 74(24): 2998-3008.
9.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
10.	Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2025, 29: ehaf194.
11.	Sorajja P, Whisenant B, Hamid N, et al. Transcatheter repair for patients with tricuspid regurgitation. N Engl J Med, 2023, 388(20): 1833-1842.
12.	Nickenig G, Lurz P, Sorajja P, et al. Percutaneous edge-to-edge repair for tricuspid regurgitation: 3-year outcomes from the TRILUMINATE study. JACC Cardiovasc Interv, 2024, 17(18): 2113-2122.
13.	Donal E, Dreyfus J, Leurent G, et al. Transcatheter edge-to-edge repair for severe isolated tricuspid regurgitation: the Tri.Fr randomized clinical trial. JAMA, 2025, 333(2): 124-132.
14.	Kodali SK, Hahn RT, Davidson CJ, et al. 1-year outcomes of transcatheter tricuspid valve repair. J Am Coll Cardiol, 2023, 81(18): 1766-1776.
15.	Wild MG, Stolz L, Rosch S, et al. Transcatheter valve repair for tricuspid regurgitation: 1-year results from a large European real-world registry. J Am Coll Cardiol, 2025, 85(3): 220-231.
16.	Ren K, Lin X, Pu Z, et al. Transcatheter edge-to-edge repair for tricuspid regurgitation in barlow-type tricuspid valve prolapse using the DragonFly-T system. JACC Case Rep, 2025, 30(10): 103926.
17.	Gray WA, Abramson SV, Lim S, et al. 1-year outcomes of cardioband tricuspid valve reconstruction system early feasibility study. JACC Cardiovasc Interv, 2022, 15(19): 1921-1932.
18.	Xu H, Chen M, Wang Z, et al. Mid-term outcomes of K-Clip transcatheter tricuspid annuloplasty system in patients with severe functional tricuspid regurgitation. JACC Cardiovasc Interv, 2024, 17(23): 2796-2807.
19.	Hahn RT, Makkar R, Thourani VH, et al. Transcatheter valve replacement in severe tricuspid regurgitation. N Engl J Med, 2025, 392(2): 115-126.
20.	Angellotti D, Mattig I, Samim D, et al. Early outcomes of real-world transcatheter tricuspid valve replacement. JACC Cardiovasc Interv, 2025, 18(15): 1896-1909.
21.	Lupu L, Rogers T, Haberman D, et al. Adverse events reported for the evoque transcatheter tricuspid valve replacement: a MAUDE database analysis. JACC Cardiovasc Interv, 2025, 18(11): 1489-1491.
22.	Pan X, Lu F, Wang Y, et al. Transcatheter tricuspid valve replacement with the novel system: 1-year outcomes from the TRAVEL study. JACC Cardiovasc Interv, 2025, 18(10): 1276-1285.
23.	Fam NP, Ong G, Estevez-Loureiro R, et al. Transcatheter tricuspid valve replacement with the cardiovalve system. JACC Cardiovasc Interv, 2024, 17(4): 586-588.
24.	Teiger E, Nejjari M, Lim P, et al. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system. EuroIntervention, 2022, 18(10): 862-864.
25.	Blasco-Turrión S, Briedis K, Estévez-Loureiro R, et al. Bicaval TricValve implantation in patients with severe symptomatic tricuspid regurgitation: 1-year follow-up outcomes. JACC Cardiovasc Interv, 2024, 17(1): 60-72.
26.	中国医师协会心血管内科医师分会结构性心脏病学组, 苏州工业园区东方华夏心血管健康研究院, 潘文志, 等. 三尖瓣反流经导管治疗的中国专家共识. 中国介入心脏病学杂志, 2024, 32(10): 551-561.
27.	McElhinney DB, Cabalka AK, Aboulhosn JA, et al. Transcatheter tricuspid valve-in-valve implantation for the treatment of dysfunctional surgical bioprosthetic valves: an international, multicenter registry study. Circulation, 2016, 133(16): 1582-1593.
28.	Condado J, Leonardi R, Babaliaros V. Percutaneous tricuspid valve-In-ring replacement for the treatment of recurrent severe tricuspid regurgitation. Catheter Cardiovasc Interv, 2015, 86(7): 1294-1298.
29.	Bouleti C, Himbert D, Brochet E, et al. Transfemoral tricuspid valve-in-ring implantation using the edwards Sapien XT valve: one-year follow-up. Circ Cardiovasc Interv, 2015, 8(3): e002225.
30.	Brener MI, Lurz P, Hausleiter J, et al. Right ventricular-pulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair. J Am Coll Cardiol, 2022, 79(5): 448-461.
31.	Grapsa J, Praz F, Sorajja P, et al. Tricuspid regurgitation: from imaging to clinical trials to resolving the unmet need for treatment. JACC Cardiovasc Imaging, 2024, 17(1): 79-95.
32.	PPark JB, Kim HK, Jung JH, et al. Prognostic value of cardiac MR imaging for preoperative assessment of patients with severe functional tricuspid regurgitation. Radiology, 2016, 280(3): 723-734.
33.	Stolz L, Weckbach LT, Karam N, et al. Invasive right ventricular to pulmonary artery coupling in patients undergoing transcatheter edge-to-edge tricuspid valve repair. JACC Cardiovasc Imaging, 2023, 16(4): 564-566.
34.	Lurz P, Orban M, Besler C, et al. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair. Eur Heart J, 2020, 41(29): 2785-2795.
35.	Gerçek M, Narang A, Körber MI, et al. GLIDE score: scoring system for prediction of procedural success in tricuspid valve transcatheter edge-to-edge repair. JACC Cardiovasc Imaging, 2024, 17(7): 729-742.
36.	Lu F, Xiong T, Chen M. Evaluation of systemic impact of tricuspid regurgitation: an appeal for the notion of tricuspid regurgitation syndrome. Chin Med J (Engl), 2023, 136(2): 138-140.
37.	Dreyfus J, Audureau E, Bohbot Y, et al. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J, 2022, 43(7): 654-662.
38.	Russo G, Pedicino D, Pires Marafon D, et al. TRIVALVE score: a risk score for mortality/hospitalization prediction in patients undergoing transcatheter tricuspid valve intervention. JACC Cardiovasc Interv, 2024, 17(18): 2170-2179.

1. Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol, 1999, 83(6): 897-902.
2. Topilsky Y, Maltais S, Medina Inojosa J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging, 2019, 12(3): 433-442.
3. Czapla J, Claus I, Martens T, et al. Midterm comparison between different annuloplasty techniques for functional tricuspid regurgitation. Ann Thorac Surg, 2022, 114(1): 134-141.
4. Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg, 2012, 143(5): 1043-1049.
5. Dhoble A, Zhao Y, Vejpongsa P, et al. National 10-year trends and outcomes of isolated and concomitant tricuspid valve surgery. J Cardiovasc Surg (Torino), 2019, 60(1): 119-127.
6. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-685.
7. Litwiński P, Kołsut P, Sitko T, et al. Results and factors associated with adverse outcome after tricuspid valve replacement. Kardiol Pol, 2018, 76(4): 731-739.
8. Taramasso M, Benfari G, van der Bijl P, et al. Transcatheter versus medical treatment of patients with symptomatic severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 74(24): 2998-3008.
9. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
10. Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2025, 29: ehaf194.
11. Sorajja P, Whisenant B, Hamid N, et al. Transcatheter repair for patients with tricuspid regurgitation. N Engl J Med, 2023, 388(20): 1833-1842.
12. Nickenig G, Lurz P, Sorajja P, et al. Percutaneous edge-to-edge repair for tricuspid regurgitation: 3-year outcomes from the TRILUMINATE study. JACC Cardiovasc Interv, 2024, 17(18): 2113-2122.
13. Donal E, Dreyfus J, Leurent G, et al. Transcatheter edge-to-edge repair for severe isolated tricuspid regurgitation: the Tri.Fr randomized clinical trial. JAMA, 2025, 333(2): 124-132.
14. Kodali SK, Hahn RT, Davidson CJ, et al. 1-year outcomes of transcatheter tricuspid valve repair. J Am Coll Cardiol, 2023, 81(18): 1766-1776.
15. Wild MG, Stolz L, Rosch S, et al. Transcatheter valve repair for tricuspid regurgitation: 1-year results from a large European real-world registry. J Am Coll Cardiol, 2025, 85(3): 220-231.
16. Ren K, Lin X, Pu Z, et al. Transcatheter edge-to-edge repair for tricuspid regurgitation in barlow-type tricuspid valve prolapse using the DragonFly-T system. JACC Case Rep, 2025, 30(10): 103926.
17. Gray WA, Abramson SV, Lim S, et al. 1-year outcomes of cardioband tricuspid valve reconstruction system early feasibility study. JACC Cardiovasc Interv, 2022, 15(19): 1921-1932.
18. Xu H, Chen M, Wang Z, et al. Mid-term outcomes of K-Clip transcatheter tricuspid annuloplasty system in patients with severe functional tricuspid regurgitation. JACC Cardiovasc Interv, 2024, 17(23): 2796-2807.
19. Hahn RT, Makkar R, Thourani VH, et al. Transcatheter valve replacement in severe tricuspid regurgitation. N Engl J Med, 2025, 392(2): 115-126.
20. Angellotti D, Mattig I, Samim D, et al. Early outcomes of real-world transcatheter tricuspid valve replacement. JACC Cardiovasc Interv, 2025, 18(15): 1896-1909.
21. Lupu L, Rogers T, Haberman D, et al. Adverse events reported for the evoque transcatheter tricuspid valve replacement: a MAUDE database analysis. JACC Cardiovasc Interv, 2025, 18(11): 1489-1491.
22. Pan X, Lu F, Wang Y, et al. Transcatheter tricuspid valve replacement with the novel system: 1-year outcomes from the TRAVEL study. JACC Cardiovasc Interv, 2025, 18(10): 1276-1285.
23. Fam NP, Ong G, Estevez-Loureiro R, et al. Transcatheter tricuspid valve replacement with the cardiovalve system. JACC Cardiovasc Interv, 2024, 17(4): 586-588.
24. Teiger E, Nejjari M, Lim P, et al. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system. EuroIntervention, 2022, 18(10): 862-864.
25. Blasco-Turrión S, Briedis K, Estévez-Loureiro R, et al. Bicaval TricValve implantation in patients with severe symptomatic tricuspid regurgitation: 1-year follow-up outcomes. JACC Cardiovasc Interv, 2024, 17(1): 60-72.
26. 中国医师协会心血管内科医师分会结构性心脏病学组, 苏州工业园区东方华夏心血管健康研究院, 潘文志, 等. 三尖瓣反流经导管治疗的中国专家共识. 中国介入心脏病学杂志, 2024, 32(10): 551-561.
27. McElhinney DB, Cabalka AK, Aboulhosn JA, et al. Transcatheter tricuspid valve-in-valve implantation for the treatment of dysfunctional surgical bioprosthetic valves: an international, multicenter registry study. Circulation, 2016, 133(16): 1582-1593.
28. Condado J, Leonardi R, Babaliaros V. Percutaneous tricuspid valve-In-ring replacement for the treatment of recurrent severe tricuspid regurgitation. Catheter Cardiovasc Interv, 2015, 86(7): 1294-1298.
29. Bouleti C, Himbert D, Brochet E, et al. Transfemoral tricuspid valve-in-ring implantation using the edwards Sapien XT valve: one-year follow-up. Circ Cardiovasc Interv, 2015, 8(3): e002225.
30. Brener MI, Lurz P, Hausleiter J, et al. Right ventricular-pulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair. J Am Coll Cardiol, 2022, 79(5): 448-461.
31. Grapsa J, Praz F, Sorajja P, et al. Tricuspid regurgitation: from imaging to clinical trials to resolving the unmet need for treatment. JACC Cardiovasc Imaging, 2024, 17(1): 79-95.
32. PPark JB, Kim HK, Jung JH, et al. Prognostic value of cardiac MR imaging for preoperative assessment of patients with severe functional tricuspid regurgitation. Radiology, 2016, 280(3): 723-734.
33. Stolz L, Weckbach LT, Karam N, et al. Invasive right ventricular to pulmonary artery coupling in patients undergoing transcatheter edge-to-edge tricuspid valve repair. JACC Cardiovasc Imaging, 2023, 16(4): 564-566.
34. Lurz P, Orban M, Besler C, et al. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair. Eur Heart J, 2020, 41(29): 2785-2795.
35. Gerçek M, Narang A, Körber MI, et al. GLIDE score: scoring system for prediction of procedural success in tricuspid valve transcatheter edge-to-edge repair. JACC Cardiovasc Imaging, 2024, 17(7): 729-742.
36. Lu F, Xiong T, Chen M. Evaluation of systemic impact of tricuspid regurgitation: an appeal for the notion of tricuspid regurgitation syndrome. Chin Med J (Engl), 2023, 136(2): 138-140.
37. Dreyfus J, Audureau E, Bohbot Y, et al. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J, 2022, 43(7): 654-662.
38. Russo G, Pedicino D, Pires Marafon D, et al. TRIVALVE score: a risk score for mortality/hospitalization prediction in patients undergoing transcatheter tricuspid valve intervention. JACC Cardiovasc Interv, 2024, 17(18): 2170-2179.

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