Who to refer to a Heart Team
Early intervention can significantly improve long-term outcomes and patient prognosis.1
Prior to intervention, the 2025 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) Guidelines recommend careful stepwise evaluation of patients with tricuspid regurgitation (TR) by a dedicated multidisciplinary Heart Team2
aFor more details on risk assessment, please refer to the 2025 ESC/EACTS Guidelines for the management of valvular heart disease.2
Refer your patients with severe TR to the Heart Team for careful evaluation and potential intervention. A multidisciplinary approach can improve outcomes and provide comprehensive care.2-4
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).2-4
The 2025 ESC/EACTS recommendations on treatment options for patients with TR2
aThe Heart Team with expertise in the treatment of TV disease evaluates anatomical eligibility for transcatheter therapy including jet location, coaptation gap, leaflet tethering, and potential interference with pacing lead.2
bRepair whenever possible, particularly in cases of moderate TR or mild TR with significant TA dilatation.2
LV: left ventricle/ventricular; RV: right ventricle/ventricular; TA: tricuspid annulus; TR: tricuspid regurgitation; TV: tricuspid valve.
The expanded, five-tier TR grading system better addresses TR severity5,6
Echocardiography is typically the initial method of evaluating TR. Three grades have been commonly used to describe TR severity: mild, moderate and severe.2,6-8 However, many studies have already adopted a more nuanced five-tier grading system, which further stratifies severe TR into severe, massive and torrential, and can better predict patient outcomes.2,5-7
TR grading system5*
*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.
It is challenging to identify the severity of TR, but we have to use all the tools at our disposal to really get an integrative assessment of TR severity*
-Dr Jordan Blair Strom, MD
Associate Professor of Medicine at Harvard Medical School
*Expert opinions, advice and all other information expressed represent contributors' views and not necessarily those of Edwards Lifesciences.
Find more information on TR and transcatheter tricuspid valve interventions (TTVIs)
References
- 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.
- 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.
- Hausleiter J, Stolz L, Lurz P, et al. Transcatheter tricuspid valve replacement. J Am Coll Cardiol. 2025;85:265–91.
- Ong G AT, Patrascu A. Who should be referred for tricuspid valve intervention? Can J Cardiol. 2025:S0828–282X(25)00235–1. doi:doi: 10.1016/j.cjca.2025.03.025.
- Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging. 2017;18(12):1342–3. doi:10.1093/ehjci/jex139.
- Hahn RT, Zamorano JL. Tricuspid regurgitation severity grades: Is more always better? Eur Heart J Cardiovasc Imaging. 2024;25(8):1087–8. doi:10.1093/ehjci/jeae143.
- Santoro C, Marco Del Castillo A, Gonzalez-Gomez 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):1035–42. doi:10.1093/ehjci/jez024.
- Zoghbi WA, Adams D, Bonow RO, 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):303–71. doi:10.1016/j.echo.2017.01.007.
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