Tricuspid regurgitation: new diagnostic and therapeutic evidences

Tricuspid regurgitation (TR) is most commonly secondary (or functional), defined as regurgitation with apparently anatomically normal leaflets and chords. The cause of secondary TR most likely is dilatation of the tricuspid anulus, tethering of the tricuspid valve (TV) leaflets, right ventricle dilatation caused by left side valvular heart diseases. Primary TR is due to processes that di- rectly affect the tricuspid valve (“organic” valve disease). TV surgery usually is performed at the time of surgery for left sided valvular heart disease. Isolated TV surgery is rarely per- formed and presents 9% operative mortality with a higher adjusted in-hospital mortality for tricuspid replacement compared with repair demonstrating that it is necessary to redefine patient selection criteria and timing for isolated surgical procedures. In recent years, new studies showed preclinical and early clinical evidences on the possibility of treating TR with transcatheter technologies like those used for mitral valve disease, either a leaflet clipping, or an annular remodeling device or a valve replace- ment prosthesis. However, despite the positive data on high-risk patients advocating for a promising future for these transcatheter technologies, they are not available for general clinical use because of anatomical limitations, and because they require advanced imaging mo- dalities for patient selection and procedural guidance. The aim of this review is to provide an updated overview and a clinical perspective on novel tricuspid valve surgical and transcatheter therapies, highlighting potential challenges and future directions