Percutaneous interventions in tricuspid valve disease: a new era in cardiac treatment

Tricuspid valve disease (TVD), primarily tricuspid regurgitation (TR), is increasingly recognized for its significant morbidity and mortality. Traditional management with medical therapy or high-risk surgical interventions leaves many patients untreated. The emergence of percutaneous interventions introduces a transformative, minimally invasive alternative for high-risk surgical candidates. Clinical trials such as TRILUMINATE have demonstrated the efficacy of devices like TriClip, achieving TR reduction to moderate or less in 86% of patients at 1 year, alongside improvements in functional capacity (6MWT) and quality of life (KCCQ scores). Real-world data from the TriValve registry revealed a 91% procedural success rate, marked improvements in the NYHA functional class, and a low complication profile. Long-term follow-up confirms sustained symptom relief, reduced edema, and improved exercise tolerance, with KCCQ scores increasing by 18-22 points. Survival benefits have also been reported, with a 35% 1-year mortality reduction compared to medical management. Although long-term data are limited, emerging transcatheter tricuspid valve replacement (TTVR) devices like EVOQUE show promising outcomes. Challenges persist in patient selection, particularly in congenital or complex structural abnormalities. Integrating advanced imaging techniques, such as 3D echocardiography, enhances procedural planning and outcome assessment. Ongoing trials like TRILUMINATE Pivotal aim to address evidence gaps, refine techniques, and expand indications. As percutaneous approaches evolve, they can revolutionize TVD management, improving survival, quality of life, and functional capacity in this high-risk population. Further research will solidify their role in contemporary cardiac care.