Indications for transcatheter interventions in tricuspid regurgitation_West China Medical Journal

Authors：

ZHANG Siyuan , SHEN Jinglun ,  ZHANG Haibo

Center for Valve and Atrial Fibrillation Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 101118, P. R. China;

Corresponding author：

ZHANG Haibo, Email: 12011306@mail.sustech.edu.cn

Keywords：

Tricuspid regurgitation; transcatheter tricuspid valve intervention; tricuspid valve surgery; right ventricular function; pulmonary vascular resistance

DOI：

10.7507/1002-0179.202510018

Video：

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Abstract Full text Figures/Tables Video References Cited by

Tricuspid regurgitation (TR) is a common but often neglected valvular heart disease. Growing evidence has highlighted its association with poor prognosis and the complexity of its management. In recent years, transcatheter tricuspid valve intervention (TTVI) has emerged as a promising minimally invasive approach, with accumulating evidence supporting its safety and short-term efficacy. Transcatheter approaches offer a new therapeutic alternative for high-risk TR patients, but the clinical indications for TTVI are still being refined. This review summarizes recent advancements in TTVI technology, compares the indications for surgical and transcatheter therapies, and discusses the critical role of right heart function and pulmonary circulation in therapeutic decision-making.

1.	Vieitez JM, Monteagudo JM, Mahia P, et al. New insights of tricuspid regurgitation: a large-scale prospective cohort study. Eur Heart J Cardiovasc Imaging, 2021, 22(2): 196-202.
2.	Yang L, Chen H, Pan W, et al. Analyses for prevalence and outcome of tricuspid regurgitation in China: an echocardiography study of 134, 874 patients. Cardiology, 2019, 142(1): 40-46.
3.	Kaneyuki D, Jordan AM, Rosen JL, et al. Isolated tricuspid valve surgery for functional tricuspid regurgitation. Thorac Cardiovasc Surg, 2025, 73(2): 111-116.
4.	von Bardeleben RS, Lurz P, Sorajja P, et al. Two-year outcomes for tricuspid repair with a transcatheter edge-to-edge valve repair from the transatlantic TRILUMINATE trial. Circ Cardiovasc Interv, 2023, 16(8): e012888.
5.	Lurz P, Stephan von Bardeleben R, Weber M, et al. Transcatheter edge-to-edge repair for treatment of tricuspid regurgitation. J Am Coll Cardiol, 2021, 77(3): 229-239.
6.	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.
7.	Chorin E, Rozenbaum Z, Topilsky Y, et al. Tricuspid regurgitation and long-term clinical outcomes. Eur Heart J Cardiovasc Imaging, 2020, 21(2): 157-165.
8.	Antunes MJ, Rodríguez-Palomares J, Prendergast B, et al. Management of tricuspid valve regurgitation: position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease. Eur J Cardiothorac Surg, 2017, 52(6): 1022-1030.
9.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
10.	Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2025: ehaf194.
11.	Gammie JS, Chu MWA, Falk V, et al. Concomitant tricuspid repair in patients with degenerative mitral regurgitation. N Engl J Med, 2022, 386(4): 327-339.
12.	Scotti A, Sturla M, Granada JF, et al. Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5, 316 patients from 35 studies. EuroIntervention, 2022, 18(10): 840-851.
13.	Zubarevich A, Szczechowicz M, Brcic A, et al. Tricuspid valve repair in isolated tricuspid pathology: a 12-year single center experience. J Cardiothorac Surg, 2020, 15(1): 330.
14.	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.
15.	Negm S, Arafat AA, Elatafy EE, et al. Mechanical versus bioprosthetic valve replacement in the tricuspid valve position: a systematic review and meta-analysis. Heart Lung Circ, 2021, 30(3): 362-371.
16.	Shih E, George TJ, DiMaio JM, et al. Contemporary outcomes of isolated tricuspid valve surgery. J Surg Res, 2023, 283: 1-8.
17.	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.
18.	Kitamura M, Fam NP, Braun D, et al. 12-Month outcomes of transcatheter tricuspid valve repair with the PASCAL system for severe tricuspid regurgitation. Catheter Cardiovasc Interv, 2021, 97(6): 1281-1289.
19.	Bruoha S, Mangieri A, Ho EC, et al. Transcatheter annular approaches for tricuspid regurgitation (cardioband and others). Interv Cardiol Clin, 2022, 11(1): 67-80.
20.	Piragine E, Veneziano S, Trippoli S, et al. Efficacy and safety of cardioband in patients with tricuspid regurgitation: systematic review and meta-analysis of single-arm trials and observational studies. J Clin Med, 2024, 13(21): 6393.
21.	Xu H, Li W, Lee AP, et al. 30-Day outcomes of transcatheter tricuspid annuloplasty with the k-clip system: a single-center, observational study. JACC Adv, 2023, 2(9): 100671.
22.	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.
23.	Zhang X, Jin Q, Pan W, et al. First-in-human study of the K-Clip^TM transcatheter annular repair system for severe functional tricuspid regurgitation. Int J Cardiol, 2023, 390: 131174.
24.	Fam NP, von Bardeleben RS, Hensey M, et al. Transfemoral transcatheter tricuspid valve replacement with the EVOQUE system: a multicenter, observational, first-in-human experience. JACC Cardiovasc Interv, 2021, 14(5): 501-511.
25.	Webb JG, Chuang AM, Meier D, et al. Transcatheter tricuspid valve replacement with the EVOQUE system: 1-year outcomes of a multicenter, first-in-human experience. JACC Cardiovasc Interv, 2022, 15(5): 481-491.
26.	Zhang Y, Lu F, Li W, et al. A first-in-human study of transjugular transcatheter tricuspid valve replacement with the LuX-Valve Plus system. EuroIntervention, 2023, 18(13): e1088-e1089.
27.	Lu FL, Ma Y, An Z, et al. First-in-man experience of transcatheter tricuspid valve replacement with LuX-Valve in high-risk tricuspid regurgitation patients. JACC Cardiovasc Interv, 2020, 13(13): 1614-1616.
28.	孙艳丹, 曹亮 , 白炜, 等. 经导管三尖瓣置换装置 Lux-Valve 与 Lux-Valve Plus 治疗重度三尖瓣反流患者的疗效比较. 浙江大学学报(医学版), 2025, 54(2): 213-218.
29.	Dannenberg V, Donà C, Koschutnik M, et al. Transcatheter treatment by valve-in-valve and valve-in-ring implantation for prosthetic tricuspid valve dysfunction. Wien Klin Wochenschr, 2021, 133(15/16): 780-785.
30.	Wu K, Shen J, Meng X, et al. Transcatheter valve-in-valve implantation treatment with the J-valve system for tricuspid bioprosthesis deterioration: a report of two cases. J Thorac Dis, 2024, 16(2): 1730-1737.
31.	Tanaka T, Sugiura A, Kavsur R, et al. Changes in right ventricular function and clinical outcomes following tricuspid transcatheter edge-to-edge repair. Eur J Heart Fail, 2024, 26(4): 1015-1024.
32.	Muntané-Carol G, Taramasso M, Miura M, et al. Transcatheter tricuspid valve intervention in patients with right ventricular dysfunction or pulmonary hypertension: insights from the TriValve Registry. Circ Cardiovasc Interv, 2021, 14(2): e009685.
33.	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.
34.	Yoshida K, van Wezenbeek J, Wessels JN, et al. Tricuspid regurgitation in pulmonary arterial hypertension: a right ventricular volumetric and functional analysis. Eur Respir J, 2024, 63(6): 2301696.
35.	Di Mauro M, Foschi M, Tancredi F, et al. Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery. Int J Cardiol, 2018, 252: 39-43.
36.	Lee SY, Jung HO, Kim KA, et al. Impact of the new definition on the prognosis of patients with pulmonary hypertension compared to the classic definition. Korean Circ J, 2025, 55(11): e97.

1. Vieitez JM, Monteagudo JM, Mahia P, et al. New insights of tricuspid regurgitation: a large-scale prospective cohort study. Eur Heart J Cardiovasc Imaging, 2021, 22(2): 196-202.
2. Yang L, Chen H, Pan W, et al. Analyses for prevalence and outcome of tricuspid regurgitation in China: an echocardiography study of 134, 874 patients. Cardiology, 2019, 142(1): 40-46.
3. Kaneyuki D, Jordan AM, Rosen JL, et al. Isolated tricuspid valve surgery for functional tricuspid regurgitation. Thorac Cardiovasc Surg, 2025, 73(2): 111-116.
4. von Bardeleben RS, Lurz P, Sorajja P, et al. Two-year outcomes for tricuspid repair with a transcatheter edge-to-edge valve repair from the transatlantic TRILUMINATE trial. Circ Cardiovasc Interv, 2023, 16(8): e012888.
5. Lurz P, Stephan von Bardeleben R, Weber M, et al. Transcatheter edge-to-edge repair for treatment of tricuspid regurgitation. J Am Coll Cardiol, 2021, 77(3): 229-239.
6. 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.
7. Chorin E, Rozenbaum Z, Topilsky Y, et al. Tricuspid regurgitation and long-term clinical outcomes. Eur Heart J Cardiovasc Imaging, 2020, 21(2): 157-165.
8. Antunes MJ, Rodríguez-Palomares J, Prendergast B, et al. Management of tricuspid valve regurgitation: position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease. Eur J Cardiothorac Surg, 2017, 52(6): 1022-1030.
9. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
10. Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2025: ehaf194.
11. Gammie JS, Chu MWA, Falk V, et al. Concomitant tricuspid repair in patients with degenerative mitral regurgitation. N Engl J Med, 2022, 386(4): 327-339.
12. Scotti A, Sturla M, Granada JF, et al. Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5, 316 patients from 35 studies. EuroIntervention, 2022, 18(10): 840-851.
13. Zubarevich A, Szczechowicz M, Brcic A, et al. Tricuspid valve repair in isolated tricuspid pathology: a 12-year single center experience. J Cardiothorac Surg, 2020, 15(1): 330.
14. 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.
15. Negm S, Arafat AA, Elatafy EE, et al. Mechanical versus bioprosthetic valve replacement in the tricuspid valve position: a systematic review and meta-analysis. Heart Lung Circ, 2021, 30(3): 362-371.
16. Shih E, George TJ, DiMaio JM, et al. Contemporary outcomes of isolated tricuspid valve surgery. J Surg Res, 2023, 283: 1-8.
17. 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.
18. Kitamura M, Fam NP, Braun D, et al. 12-Month outcomes of transcatheter tricuspid valve repair with the PASCAL system for severe tricuspid regurgitation. Catheter Cardiovasc Interv, 2021, 97(6): 1281-1289.
19. Bruoha S, Mangieri A, Ho EC, et al. Transcatheter annular approaches for tricuspid regurgitation (cardioband and others). Interv Cardiol Clin, 2022, 11(1): 67-80.
20. Piragine E, Veneziano S, Trippoli S, et al. Efficacy and safety of cardioband in patients with tricuspid regurgitation: systematic review and meta-analysis of single-arm trials and observational studies. J Clin Med, 2024, 13(21): 6393.
21. Xu H, Li W, Lee AP, et al. 30-Day outcomes of transcatheter tricuspid annuloplasty with the k-clip system: a single-center, observational study. JACC Adv, 2023, 2(9): 100671.
22. 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.
23. Zhang X, Jin Q, Pan W, et al. First-in-human study of the K-Clip^TM transcatheter annular repair system for severe functional tricuspid regurgitation. Int J Cardiol, 2023, 390: 131174.
24. Fam NP, von Bardeleben RS, Hensey M, et al. Transfemoral transcatheter tricuspid valve replacement with the EVOQUE system: a multicenter, observational, first-in-human experience. JACC Cardiovasc Interv, 2021, 14(5): 501-511.
25. Webb JG, Chuang AM, Meier D, et al. Transcatheter tricuspid valve replacement with the EVOQUE system: 1-year outcomes of a multicenter, first-in-human experience. JACC Cardiovasc Interv, 2022, 15(5): 481-491.
26. Zhang Y, Lu F, Li W, et al. A first-in-human study of transjugular transcatheter tricuspid valve replacement with the LuX-Valve Plus system. EuroIntervention, 2023, 18(13): e1088-e1089.
27. Lu FL, Ma Y, An Z, et al. First-in-man experience of transcatheter tricuspid valve replacement with LuX-Valve in high-risk tricuspid regurgitation patients. JACC Cardiovasc Interv, 2020, 13(13): 1614-1616.
28. 孙艳丹, 曹亮 , 白炜, 等. 经导管三尖瓣置换装置 Lux-Valve 与 Lux-Valve Plus 治疗重度三尖瓣反流患者的疗效比较. 浙江大学学报(医学版), 2025, 54(2): 213-218.
29. Dannenberg V, Donà C, Koschutnik M, et al. Transcatheter treatment by valve-in-valve and valve-in-ring implantation for prosthetic tricuspid valve dysfunction. Wien Klin Wochenschr, 2021, 133(15/16): 780-785.
30. Wu K, Shen J, Meng X, et al. Transcatheter valve-in-valve implantation treatment with the J-valve system for tricuspid bioprosthesis deterioration: a report of two cases. J Thorac Dis, 2024, 16(2): 1730-1737.
31. Tanaka T, Sugiura A, Kavsur R, et al. Changes in right ventricular function and clinical outcomes following tricuspid transcatheter edge-to-edge repair. Eur J Heart Fail, 2024, 26(4): 1015-1024.
32. Muntané-Carol G, Taramasso M, Miura M, et al. Transcatheter tricuspid valve intervention in patients with right ventricular dysfunction or pulmonary hypertension: insights from the TriValve Registry. Circ Cardiovasc Interv, 2021, 14(2): e009685.
33. 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.
34. Yoshida K, van Wezenbeek J, Wessels JN, et al. Tricuspid regurgitation in pulmonary arterial hypertension: a right ventricular volumetric and functional analysis. Eur Respir J, 2024, 63(6): 2301696.
35. Di Mauro M, Foschi M, Tancredi F, et al. Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery. Int J Cardiol, 2018, 252: 39-43.
36. Lee SY, Jung HO, Kim KA, et al. Impact of the new definition on the prognosis of patients with pulmonary hypertension compared to the classic definition. Korean Circ J, 2025, 55(11): e97.

West China Medical Journal

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