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Transcatheter tricuspid intervention: ready for primetime?

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. In clinical practice, tricuspid regurgitation (TR) is a common finding and can frequently be observed during routine echocardiography—as an incidental finding or as a consequence of leading leftsided heart diseases (as secondary TR (sTR)). Populationbased data regarding the prevalence of TR are divergent—mainly due to different (echocardiographic) classification; the Framingham Heart Study showed a prevalence of mild TR in overall >80% of the population—particularly affecting people at older age and of female gender. Consequently and with regard to the elderly (>70 years), a significant TR (≥moderate) was present in 1.5% of male and 5.6% of female patients, respectively. Thus, clinically relevant TR can be anticipated in approximately 3 million individuals in Europe and 1.5 million individuals in the USA. Moreover, prevalence of ≥moderate TR in patients with chronic heart failure and reduced left ventricular ejection fraction is even higher with approximately 26%. 5 6 The importance of TR for prognosis has long been underrated and treatment has subsequently been neglected in accordance with the initial recommendations to handle TR with optimal heart failure therapy. 7 8 Especially, significant sTR can long remain silent, compensated and asymptomatic, thus complicating treatment and decision making; moreover, sTR—particularly refractory sTR—stands as a marker for progressed heart failure with unfavourable outcome, high morbidity and mortality. 6 9–11 In particular, preinterventional sTR in patients after interventional mitral valve repair only improved postinterventionally in roughly one third and persisting or even progressing sTR was simultaneously associated with worse outcome. 13 Given the fact that the demographic change results in a near doubling of the population >65 years of age until 2050, 14 management of significant TR will pose a growing challenge for general practitioners and cardiologists. Development of minimally invasive and catheterbased treatment strategies has therefore come to the fore to offer the growing patient collective at high surgical risk—mainly due to advanced age and multiple comorbidities—effective and personalised therapy options.