Treatment of Tricuspid Valve Disease

In the landscape of valvular heart disease, the tricuspid valve has traditionally been dubbed the forgotten valve. However, over the last several years, studies have demonstrated that tricuspid valve disease is increasing in prevalence due to a growing aging population, and tricuspid regurgitation, in particular, is associated with increased mortality and morbidity. Traditional surgical tricuspid valve replacement or repair is often an undesirable option for patients with severe tricuspid regurgitation due to the high rates of concurrent comorbidities seen in this patient population; accordingly, treatment has traditionally been largely confined to symptom management with medical therapy. More recently, however, the field has experienced a major paradigm shift toward transcatheter interventions. Pivotal trials evaluating transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement have shown that these therapies safely achieve robust tricuspid regurgitation reduction, reduce heart failure hospitalization, and significantly improve patient-reported quality of life in the short term. These technologies have been key in providing treatment options for a large, previously underserved patient population, but further research is needed to establish the durability of these devices and to evaluate the cost-effectiveness of these interventions within a value-based healthcare framework.