Contemporary Management of Failed Tricuspid Valve Prosthesis

Failure of tricuspid valve prostheses is an increasingly encountered and complex clinical problem. Patients often present with advanced comorbidities, progressive right ventricular dysfunction, and prohibitive surgical risk. Despite growing burden, high-quality evidence and clear guideline-directed strategies remain limited. This narrative review summarizes contemporary approaches to the management of failed tricuspid valve prostheses, which include traditional redosurgical re-intervention, minimal invasive and beating-heart surgical techniques, and transcatheter valve-in-valve and valve-in-ring implantation, as well as emerging therapies for failed transcatheter tricuspid devices. Redo tricuspid valve surgery has historically carried substantial perioperative risk, although outcomes have improved at experienced centers, particularly with less invasive surgical approaches. Transcatheter valve-in-valve and valve-in-ring procedures demonstrate a high procedural success rate and favorable early outcomes in selected patient profiles with failed bioprosthetic valves or annuloplasty rings. However, durability beyond short to mid-term remains uncertain, especially in younger individuals. Given the heterogeneity of the prosthesis types and patients' profiles, the management should be individualized. A multidisciplinary Heart Team approach that integrates surgical risk, right ventricular function, prosthesis characteristics, and anatomic considerations is essential to optimize outcomes in this high-risk patient population. Given the limited and heterogeneous nature of currently available evidence, this review was designed as a clinically focused narrative review rather than a formal systematic review or meta-analysis.