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Tricuspid
Regurgitation

Tricuspid Regurgitation (TR) is a complex disease that has multiple causes, and is associated with high rates of morbidity and mortality.1,2 TR is highly prevalent, and among valve diseases, is one of the most undertreated.1,3 If left untreated, TR initiates a cascade of events that can lead to right-sided Heart Failure (HF) and death.4

The European Society of Cardiology/European Association of Cardiothoracic Surgery (ESC/EACTS) guidelines 2021 recommend timely referral of patients with VHD before irreversible damage occurs, and suggest that tricuspid valve interventions are underused and often initiated too late.39

Treatment of TR is guided by disease classification (primary/secondary) and severity. Typically, patients with TR are classified as having none/mild, moderate, or severe TR.22,45–47 In secondary TR, the approach to treatment is guided by the nature of the patient’s underlying heart disease.13

Current options for the treatment of TR include:

MEDICAL
MANAGEMENT

SURGICAL REPAIR
OR REPLACEMENT

TRANSCATHETER
REPAIR

As recommended in the 2020 American College of Cardiology/American Heart Association (ACC/AHA) and 2021 ESC/EACTS guidelines,38,39 patients with TR should be managed by a multidisciplinary heart team. A heart team comprises clinical and interventional cardiologists, cardiac surgeons, imaging specialists with expertise in interventional imaging, cardiovascular anaesthesiologists, and other specialists if required (e.g. heart failure specialists, electrophysiologists).39 Comprehensive imaging includes both TTE and TEE.48

 

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References
  1. Topilsky Y, Maltais S, Medina Inojosa J et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging. 2019;12(3):433–442. doi.org/10.1016/j.jcmg.2018.06.014.
  2. Taramasso M, Gavazzoni M, Maisano F. Is tricuspid regurgitation a prognostic interventional target or is it just an indicator of worst prognosis in heart failure patients? Eur Heart J. 2019;40(5):485–487. doi.org/10.1093/eurheartj/ehy722.
  3. Enriquez-Sarano M, Messika-Zeitoun D, Topilsky Y et al. Tricuspid regurgitation is a public health crisis. Prog Cardiovasc Dis. 2019;62(6):447–451. doi.org/10.1016/j.pcad.2019.10.009.
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  5. Vemulapalli S, Kerr MSD, Roberts GJ et al. Tricuspid valve disease prevalence and the impact of tricuspid valve surgery on cardiovascular events and hospital resource use in medicare beneficiaries. Am Heart J. 2022;245:100–109. doi.org/10.1016/j.ahj.2021.12.001.
  6.  Amat-Santos IJ, Castrodeza J, Nombela-Franco L et al. Tricuspid but not mitral regurgitation determines mortality after TAVI in patients with non-severe mitral regurgitation. Rev Esp Cardiol (Engl Ed). 2018;71(5):357–364. doi.org/10.1016/j.rec.2017.08.019.
  7. Kammerlander AA, Marzluf BA, Graf A et al. Right ventricular dysfunction, but not tricuspid regurgitation, is associated with outcome late after left heart valve procedure. J Am Coll Cardiol. 2014;64(24):2633–2642. doi.org/10.1016/j.jacc.2014.09.062.
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