Transcatheter tricuspid valve replacement: will it prevail?

Zhang Xiling ¹ Nina Pommert ² David Meier ^3,4 Stephanie Sellers ⁵ Hatim Seoudy ¹ Oliver Mueller ¹ Derk Frank ¹ Tim Attmann ¹ Rouven Berndt ¹ Gregor Warnecke ¹ Thomas Puehler ^2,6* Georg Lutter ^1*

• ¹ University Medical Center Schleswig-Holstein, Kiel, Germany
• ² Department of Cardiac and Thoracic vascular Surgery, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany, Klinik für Herz- und Thoraxgefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
• ³ Université de Lausanne, Lausanne, Vaud, Switzerland
• ⁴ Lausanne University Hospital, Lausanne, Geneva, Switzerland
• ⁵ Center for Heart Valve Innovation & Cardiovascular Translational Laboratory, St Paul’s Hospital, University of British Columbia, Vancouver, Canada, Vancouver, British Columbia, Canada
• ⁶ Department of Cardiac and Thoracic vascular Surgery, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany, University Medical Center Schleswig-Holstein, Kiel, Germany

Severe tricuspid regurgitation (TR) is a prevalent and challenging condition associated with poor survival outcomes and significant morbidity. Medical therapy alone often fails to provide adequate symptom relief, and stand-alone surgical intervention is linked to high mortality rates, making it a less favorable option unless combined with leftsided valve surgery.The advent of transcatheter tricuspid interventions has provided new therapeutic possibilities, particularly for high-risk patients who are ineligible for conventional surgery.However, many patients are still unsuited for transcatheter tricuspid repair or have only limited benefits from such procedures. In this context, Transcatheter tricuspid valve replacement (TTVR) has rapidly emerged as a promising alternative, offering the potential for more effective treatment outcomes. This review explores the latest advancements in TTVR devices, highlights key clinical findings, and discusses the challenges and limitations of this evolving strategy. Additionally, we address patient selection criteria, procedural outcomes, and future directions in the field, emphasizing the potential of TTVR to transform the management of severe TR.