Management of Tricuspid Valve Regurgitation Consensus Recommendations

Tricuspid regurgitation (TR) is a prevalent condition historically associated with high mortality and underrecognition. While medical therapy remains common, standalone surgical interventions involve significant perioperative risks. This has led to the emergence of transcatheter tricuspid valve interventions (TTVI) as a vital alternative for high-risk patients. Initiated and led by the Gulf Interventional Society, a multidisciplinary panel of experts was brought together to develop the current evidence and formulate a regional consensus and evidence-based recommendations for the management of tricuspid valve regurgitation in the Gulf region. TR is classified into primary (10%) and secondary (90%) types, with secondary TR further divided into atrial and ventricular subtypes. Evaluation relies on multimodality imaging, with echocardiography as the cornerstone and cardiac magnetic resonance for right ventricular assessment. While medical therapy focuses on decongestion, it does not modify TR progression. Surgical repair remains the gold standard for low-to-intermediate risk patients, but early referral is critical to avoid futile procedures in advanced disease. TTVI options, including edge-to-edge repair and replacement, are expanding in the Gulf, though regional adoption is hampered by fragmented healthcare systems and late presentations. Effective TR management in the Gulf requires a transition toward patient-centered care, early identification by primary care physicians, and a multidisciplinary "Heart Team" approach. Integrating digital health tools and establishing regional registries are essential to improving clinical outcomes and survival.