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Let’s turn the page on tricuspid regurgitation

For too long, treatment options for patients with severe tricuspid regurgitation (TR) have been limited, compromising their quality of life and clinical outcomes.1,2 Now, it's the time to address symptomatic, severe or greater TR and potentially offer symptom relief.3,4

TR is a prevalent, often undertreated and life-threatening condition5–7

3 million people

Three million people in Europe are estimated to have moderate or greater TR8

Fewer than 1% of patients image

Fewer than 1% of patients with moderate-to-severe TR receive surgical treatment annually6,7

Moderate or greater TR is found in 6% of echocardiograms in Europe9*

TR Echocardiograms chart

Moderate or greater TR is more common in female patients9*

63% female patients chart

*Based on data from Spain.

The prevalence of moderate or greater TR is comparable to severe aortic stenosis in people >75 years10,11

Moderate or greater TR image

Moderate or greater TR10

Severe aortic stenosis

Severe aortic stenosis11

The risk is clear

Moderate or greater TR leads to elevated mortality independently of other cardiovascular conditions.12

The risk ratio remains ≥1.50 after adjusting for atrial fibrillation, mitral regurgitation, right ventricular (RV)  dysfunction, systolic pulmonary arterial pressure and left ventricular ejection fraction.12

x2

Two-fold increase in all-cause mortality risk versus no/mild TR12

grey heart

TR severity significantly impacts survival 

Moderate or greater TR secondary to heart failure (HF) is associated with excess mortality.13

TR severity significantly impacts survival

†Based on a retrospective, observational study in Germany.

Historically, the treatment options for TR have been limited, leading to mixed outcomes.1,15

Medical therapy
  • 2025 European Society of Cardiology (ESC) and European Association for Cardiothoracic Surgery (EACTS) guidelines for the management of valvular heart disease acknowledge that medical therapy for TR may be useful in the presence of HF symptoms, but they do not include a recommendation
  • The recommended medical therapy for TR includes optimal HF treatment, pulmonary vasodilators for pulmonary hypertension and rhythm control for atrial fibrillation
    • For HF symptoms, diuretics should be initiated, beginning with loop diuretics eventually combined with aldosterone antagonists, thiazide diuretics, and/or sodium glucose transport 2 (SGLT2) inhibitors
Surgery
  • 2025 ESC/EACTS guidelines for the management of valvular heart disease recommend surgery in patients with severe primary or secondary TR undergoing left-sided valve surgery (Class I/B)
  • Surgery is also recommended in symptomatic patients with isolated severe primary TR without severe RV dysfunction or severe pulmonary hypertension (Class I/C)
  • Isolated TR surgery is associated with high (8–10%) in-hospital mortality, but earlier referral and more effective techniques have shown improved outcomes in recent studies

Transcatheter tricuspid valve intervention (TTVI) should be considered to improve quality of life and RV remodelling in high-risk patients with severe, symptomatic TR despite medical therapy, in the absence of severe RV dysfunction or pre-capillary pulmonary hypertension16

TTVI could rewrite your patient’s story2,18,19

Minimally invasive TTVI has emerged as a potential treatment for TR, offering an option for high-risk patients with symptomatic, severe TR.16 Patients may experience less pain, shorter hospital stays and faster recovery times.20–22

How is TTVI performed? 

Across several studies, TTVI + medical therapy outperformed medical therapy alone 3,4,23-26

TTVI offers additional benefits beyond medical therapy, including TR reduction, reduced HF hospitalisation (HFH) and improved functional capacity and quality of life outcomes. 3,4,23-26

Learn more about TTVI

For patients with massive/torrential TR, transcatheter tricuspid valve replacement (TTVR) versus medical therapy alone demonstrated:26

TTVR versus OMT

*p=0.045; †p=0.030; both at 18 months post TTVR.

Download TTVR clinical summary
28 percent
Relative risk reduction in HFH with TEER25
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2025 ESC/EACTS Guidelines

2025 ESC/EACTS Guidelines for the management of valvular heart disease recommend that, prior to intervention, careful evaluation of TR aetiology, stage of the disease, patient operative risk and likelihood of recovery is carried out by a multidisciplinary Heart Team in patients with severe TR (Class I/C).16

Learn about the key changes

Refer your severe, symptomatic TR patients today for a Heart Team evaluation  

A Heart Team’s multidisciplinary approach means that your patients will receive a thorough evaluation and a personalised treatment plan.10,16

MR treatment plan
Who is eligible?

References

  1. Sala A, Hahn RT, Kodali SK, et al. Tricuspid valve regurgitation: Current understanding and novel treatment options. J Soc Cardiovasc Angiogr Interv. 2023;2(5):101041. doi:10.1016/j.jscai.2023.101041. 
  2. Taramasso M. Expanding the tools for transcatheter tricuspid valve intervention: Transcatheter tricuspid valve repair. JACC Case Rep. 2020;2(8):1112–1114. doi:10.1016/j.jaccas.2020.05.056. 
  3. Cai S, Bowers N, Dhoot A, et al. Natural history of severe tricuspid regurgitation: Outcomes after transcatheter tricuspid valve intervention compared to medical therapy. Int J Cardiol. 2020;320:49–54. doi:10.1016/j.ijcard.2020.07.018. 
  4. Hahn RT, Makkar R, Thourani VH, et al. Transcatheter valve replacement in severe tricuspid regurgitation. N Engl J Med. 2024;392(2):115–26. doi:10.1056/NEJMoa2401918. 
  5. Topilsky Y, Nkomo VT, Vatury O, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging. 2014;7(12):1185–94. doi:10.1016/j.jcmg.2014.07.018. 
  6. Fender EA, Zack CJ, Nishimura RA. Isolated tricuspid regurgitation: Outcomes and therapeutic interventions. Heart. 2018;104(10):798–806. doi:10.1136/heartjnl-2017-311586. 
  7. Ascione G, Del Forno B, Carino D, et al. Treatment of isolated tricuspid regurgitation in 2020: An update. Fac Rev. 2020;9:26. doi:10.12703/r/9-26. 
  8. Henning RJ. Tricuspid valve regurgitation: Current diagnosis and treatment. Am J Cardiovasc Dis. 2022;12(1):1–18.  
  9. 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. doi:10.1093/ehjci/jeaa205. 
  10. Dernektsi C, Tanaka T, Vogelhuber J, et al. Tricuspid regurgitation – Part 2: Treatment options. Accessed 19 March 2025, https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options 
  11. Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62(11):1002–12. doi:10.1016/j.jacc.2013.05.015. 
  12. Wang N, Fulcher J, Abeysuriya N, et al. Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: A systematic review and meta-analysis. Eur Heart J. 2019;40(5):476–484. doi:10.1093/eurheartj/ehy641. 
  13. Heitzinger G, Pavo N, Koschatko S, et al. Contemporary insights into the epidemiology, impact and treatment of secondary tricuspid regurgitation across the heart failure spectrum. Eur J Heart Fail. 2023;25(6):857–67. doi:10.1002/ejhf.2858. 
  14. Bannehr M, Edlinger CR, Kahn U, et al. Natural course of tricuspid regurgitation and prognostic implications. Open Heart. 2021;8(1)doi:10.1136/openhrt-2020-001529. 
  15. Al-Hijji M, Fender EA, El Sabbagh A, et al. Current treatment strategies for tricuspid regurgitation. Curr Cardiol Rep. 2017;19(11):106. doi:10.1007/s11886-017-0920-4. 
  16. Praz F, Borger MA, Lanz J, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2025; doi: 10.1093/eurheartj/ehaf194. Epub ahead of print.
  17. Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol. 2017;70(24):2953–2960. doi:10.1016/j.jacc.2017.10.039. 
  18. Kodali S. TRISCEND II trial: A randomized trial of transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. Presented at: TCT; 23–26 October 2023, San Francisco, CA, USA.
  19. Hausleiter J. Transcatheter tricuspid valve repair: TriCLASP study 1-year results. Presented at: PCR London Valves; 24–26 November 2024 London, UK.  
  20. Khan MS, Baqi A, Tahir A, et al. National estimates for the percentage of all readmissions with demographic features, morbidity, overall and gender-specific mortality of transcutaneous versus open surgical tricuspid valve replacement/repair. Cardiol Res. 2024;15(4):223–232. doi:10.14740/cr1625. 
  21. Barker CM, Goel K. Transcatheter tricuspid interventions: Past, present, and future. Methodist Debakey Cardiovasc J. 2023;19(3):57–66. doi:10.14797/mdcvj.1250. 
  22. Columbia University Department of Medicine. Tricuspid valve treatments. Accessed 21 March 2025, https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/patient-care/conditions-and-treatments/tricuspid-valve-treatments 
  23. 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. doi:10.1001/jama.2024.21189. 
  24. Wang Y, Liu Y, Meng X, et al. Comparing outcomes of transcatheter tricuspid valve replacement and medical therapy for symptomatic severe tricuspid regurgitation: a retrospective study. Eur J Med Res. 2024;29(1):407. doi:10.1186/s40001-024-01947-9. 
  25. Kar S, Makkar RR, Whisenant BK, et al. Two-Year Outcomes of Transcatheter Edge-to-Edge Repair for Severe Tricuspid Regurgitation: The TRILUMINATE Pivotal Randomized Controlled Trial. Circulation. 2025;151(23):1630–1638. doi:10.1161/circulationaha.125.074536. 
  26. Lurz P, Hahn RT, Kodali S, et al. Tricuspid valve replacement outcomes by baseline tricuspid regurgitation severity: the TRISCEND II trial. Eur Heart J. 2025;doi:10.1093/eurheartj/ehaf676.  
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