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during a 2-year follow-up period.725 In turn, the need of pacemaker implantation after surgery led to a subsequent increase in HF hospitalizations, endocarditis, and mortality.729 Annuloplasty may therefore be considered after careful evaluation of the risk factors for progressive annular dilatation and TR (AF, RA size, pulmonary pressures, etc.), balancing against the risk of possible pacemaker implantation (Supplementary data online, Table S5).732 11.4.2 Transcatheter techniques Several transcatheter approaches for the treatment of TR have been developed, including TEER, direct annuloplasty, and orthotopic and heterotopic TV replacement. Data from large multicentre registries, singlearm clinical trials, and two recent RCTs in patients with severe TR at intermediate and high risk for surgery have shown the safety of transcatheter repair, as well as the ability to reduce TR to moderate or less in Patient with tricuspid regurgitation Need for left-sided valve surgery Severe primary or secondary TR RV dilatation or RV function deterioration Appropriate for surgery according to the Heart Team Moderate or severe primary or secondary TR Severe RV/LV dysfunction or severe pre-capillary pulmonary hypertension Mild secondary TR No concomitant TV surgery Medical therapy Transcatheter therapya TV surgeryb TA dilatation (≥40 mm or >21 mm/m2) Symptomatic Severity/aetiology of TR Severity/aetiology of TR Figure 17 Management of patients with tricuspid regurgitation. LV, left ventricle/left ventricular; RV, right ventricle/right ventricular; TA, tricuspid annulus; TR, tricuspid regurgitation; TV, tricuspid valve. aThe Heart Team with expertise in the treatment of TV disease evaluates anatomical eligibility for transcatheter therapy including jet location, coaptation gap, leaflet tethering, and potential interference with pacing lead. bRepair whenever possible, particularly in cases of moderate TR or mild TR with significant TA dilatation. Downloaded from academic.oup.com/eurheartj/article/46/44/4635/8234488 by guest on 07 October 2026