Indication and timing in tricuspid interventions

Tricuspid regurgitation (TR), previously considered a secondary valvular disorder with limited clinical implications, is now recognized as a progressive and prognostically significant disease. The increasing prevalence due to aging populations and common comorbidities, such as atrial fibrillation and heart failure, has underscored the clinical urgency of addressing TR effectively. Transcatheter tricuspid valve interventions (TTVI) have emerged as valuable therapeutic alternatives, especially for patients at high surgical risk. This review addresses critical clinical questions regarding optimal intervention timing, patient selection, and treatment strategies, focusing particularly on disease progression, right-ventricular (RV) function, and recent clinical evidence. It emphasizes the importance of early identification and monitoring through echocardiographic and laboratory parameters, comprehensive risk stratification including pulmonary hypertension assessment, and the practical use of predictive tools such as TRISCORE. We summarize current guidelines for surgical versus transcatheter interventions and discuss advancements and limitations of transcatheter therapies, particularly transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR). Ultimately, individualized decision-making based on anatomical considerations, RV function, and comorbidity burden is vital to maximizing therapeutic outcomes.