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Who to refer to a Heart Team

Early intervention can significantly improve long-term outcomes and patient prognosis.1

Linda
Linda

The expanded, five-tier tricuspid regurgitation (TR) grading system better addresses TR severity2,3

Echocardiography is typically the initial method of evaluating TR. Three grades of TR have been commonly used to describe TR severity: mild, moderate and severe.3-6 However, many studies have already adopted a more nuanced five-tier grading system, which further stratifies severe TR into severe, massive and torrential, which can better predict patient outcomes.2–5

TR grading system2*

TR grading system

*Adapted from Hahn and Zamorano. Eur Heart J Cardiovasc Imaging. 2017;18(12):1342–1343. 

a3D VCA and quantitative Doppler EROA cut-offs may be larger than PISA EROA.


3D VCA: three-dimensional vena contracta area; EROA: effective regurgitant orifice area; TR: tricuspid regurgitation; PISA: proximal isovelocity surface area; VC: vena cava.

Refer your severe, symptomatic TR patients on medical therapy to the Heart Team 

Refer your patients with moderate or severe TR on guideline-directed medical therapy (GDMT) to the Heart Team for evaluation and potential intervention. A multidisciplinary approach can improve outcomes and provide comprehensive care.7,8

MR treatment plan

The Heart Team builds on the foundation of the care you provide 

Shared decision making with you (cardiologists), your patients and the Heart Team is essential in selecting the optimal treatment for TR.  The Heart Team will consider factors such as anatomy, comorbidities and procedural risks, before developing a comprehensive treatment plan and proceeding with tricuspid transcatheter edge-to-edge repair (T-TEER).7,8

MR treatment plan

Patient story

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Find more information on TR and transcatheter tricuspid valve interventions (TTVIs)

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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. Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging. 2017;18(12):1342–1343. doi:10.1093/ehjci/jex139.
  3. Hahn RT, Zamorano JL. Tricuspid regurgitation severity grades: Is more always better? Eur Heart J Cardiovasc Imaging. 2024;25(8):1087–1088. doi:10.1093/ehjci/jeae143.
  4. Vahanian A, Beyersdorf F, Praz F, et al. 2021 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. 2022;43(7):561–632. doi:10.1093/eurheartj/ehab395.
  5. Santoro C, Marco Del Castillo A, González-Gómez A, et al. Mid-term outcome of severe tricuspid regurgitation: Are there any differences according to mechanism and severity? Eur Heart J Cardiovasc Imaging. 2019;20(9):1035–1042. doi:10.1093/ehjci/jez024.
  6. Zoghbi WA, David A, Robert OB, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance.  J Am Soc Echocardiogr. 2017;30(4):303-371. doi: 10.1016/j.echo.2017.01.007.
  7. Hausleiter J, Stolz L, Lurz P, et al. Transcatheter tricuspid valve replacement. J Am Coll Cardiol. 2025;85(3):265–291. doi:10.1016/j.jacc.2024.10.071.
  8. Ong G AT, Patrascu A. Who should be referred for tricuspid valve intervention? Can J Cardiol. 2025:S0828-282X(25)00235-1. doi: 10.1016/j.cjca.2025.03.025.
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