Tricuspid valve edge to edge repair vs replacement - a comparative analysis and future directions

Tricuspid regurgitation (TR) is a common yet underrecognized valvular disease associated with significant morbidity and mortality. Recent advances in transcatheter therapies, namely transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott) and transcatheter tricuspid valve replacement (TTVR) with the EVOQUE device (Edwards Lifesciences), offer promising alternatives to surgery for severe symptomatic TR. This review compares both approaches with a focus on safety, procedural considerations, and clinical outcomes. Treating TR remains uniquely challenging due to the anatomical complexity of the valve, frequent lead interference, and common coexistence of RV dysfunction, atrial fibrillation, and pulmonary hypertension. Many affected patients are elderly and frail, rendering them poor surgical candidates. Optimal treatment requires individualized decision-making guided by detailed imaging and assessment of RV function and valvular anatomy. Both therapies achieve significant TR reduction, yet each carries distinct risks: TTVR is associated with higher rates of pacemaker implantation, bleeding, and RV failure, while T-TEER may lead to single leaflet device attachment (SLDA), leaflet injury, or residual TR. Careful patient selection is essential. Despite encouraging short-term outcomes, long-term data are needed to determine survival benefit and durability. Further studies are warranted to refine technique and optimize candidate selection.