Tricuspid Valve Regurgitation and Surgical Interventions

Tricuspid valve regurgitation (TR) occurs when the leaflets of the tricuspid valve fail to coapt fully during right ventricular systole, permitting retrograde blood flow into the right atrium. This condition ranges from mild, often asymptomatic forms, to severe regurgitation associated with right heart failure, systemic congestion and diminished exercise capacity. In recent decades it has become clear that significant TR carries an adverse prognosis, independent of left-sided heart disease. Pathophysiologically, TR may be primary, owing to intrinsic leaflet pathology, or secondary (functional), driven by annular dilatation and right ventricular remodelling in the context of atrial fibrillation, pulmonary hypertension or right ventricular dysfunction. Traditional surgical management has emphasised tricuspid annuloplasty with prosthetic rings or suture techniques, often performed concomitantly with left-sided procedures. In cases of advanced leaflet damage or severe tethering, valve replacement may be favoured. Despite low procedural mortality in expert centres, isolated tricuspid surgery has historically been delayed until advanced symptoms emerge, contributing to suboptimal outcomes. More recently, transcatheter therapies have been introduced to offer less invasive options for high-risk patients. These include edge-to-edge leaflet clipping, spacer devices to occupy the regurgitant orifice and transcatheter annuloplasty systems designed to reduce annular dimensions. Early clinical experience demonstrates symptom relief, reduction in regurgitant volume and improvements in right ventricular geometry. Ongoing refinements in device design, patient selection and imaging guidance hold promise for expanding therapeutic choices and improving long-term prognosis.

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Tricuspid Valve Regurgitation and Surgical Interventions publication trend

The graph below shows the total number of articles in tricuspid valve regurgitation and surgical interventions across all publications each year (not limited to Nature Index journals).

Technical terms

Tricuspid regurgitation (TR): Retrograde flow of blood from the right ventricle into the right atrium due to incomplete leaflet closure.

Annuloplasty: Surgical or transcatheter technique to reduce tricuspid annulus size and restore leaflet coaptation.

Transcatheter edge-to-edge repair: Percutaneous procedure that approximates valve leaflets using a clip device to reduce regurgitation.

Atrial functional tricuspid regurgitation (AFTR): TR secondary to annular dilatation from right atrial enlargement, typically in atrial fibrillation, with preserved right ventricular geometry.

Ventricular functional tricuspid regurgitation (VFTR): TR driven by right ventricular dilatation or dysfunction, causing annular expansion and leaflet tethering.

References

1. Impact of Severe Tricuspid Regurgitation on Long Term Survival. Research in Cardiovascular Medicine (2013).
2. Short-Term Clinical Outcomes of Transcatheter Tricuspid Valve Repair With the Third-Generation MitraClip XTR System. JACC Cardiovascular Interventions (2021).
3. Advances in transcatheter mitral and tricuspid therapies. BMC Cardiovascular Disorders (2020).
4. Prognostic implications of atrial vs. ventricular functional tricuspid regurgitation.. European Heart Journal - Cardiovascular Imaging (2023).
5. The atrial secondary tricuspid regurgitation is associated to more favorable outcome than the ventricular phenotype. Frontiers in Cardiovascular Medicine (2022).
6. Tricuspid valve disease and cardiac implantable electronic devices. European Heart Journal (2023).
7. Transcatheter Tricuspid Valve Intervention: Coaptation Devices. Frontiers in Cardiovascular Medicine (2020).