Contemporary insights and evolving clinical pathways in transcatheter tricuspid valve replacement

Transcatheter tricuspid valve replacement (TTVR) has emerged as an important therapeutic option for patients with severe tricuspid regurgitation (TR), particularly those with high surgical risk and complex anatomy. This review summarizes the current state of orthotopic TTVR, including patient selection, procedural considerations, and post-procedural care. Recent data demonstrate that TTVR provides consistent results and effective TR elimination, promotes reverse right ventricular (RV) remodeling, and improves symptoms and quality of life. In patients with massive or torrential baseline TR, TTVR has also been associated with reduced heart failure hospitalizations. Key challenges include conduction disturbances, bleeding complications, risk of afterload mismatch, and the need for long-term anticoagulation. As multiple devices become available, careful multidisciplinary evaluation, incorporating valve anatomy, RV function, pulmonary pressures, imaging quality, and comorbid conditions, remains essential for optimal therapy selection.