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Transcatheter tricuspid intervention: ready for primetime?
  1. Johanna Vogelhuber,
  2. Marcel Weber,
  3. Georg Nickenig
  1. Heart Center Bonn, University Hospital Bonn, Bonn, Germany
  1. Correspondence to Professor Georg Nickenig, Heart Center Bonn, Department of Medicine II, Universitatsklinikum Bonn Medizinische Klinik II Innere Medizin Kardiologie Angiologie und Pneumologie, Bonn 53127, Germany; Georg.Nickenig{at}

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Learning objectives

  • To learn about prevalence, possible aetiologies and pathophysiology of tricuspid regurgitation (TR).

  • To find out more about currently available catheter-based treatment options for TR and the ongoing research in the field of interventional tricuspid valve therapy.

  • To learn about general considerations and criteria regarding patient selection, device selection and optimal timing for transcatheter tricuspid intervention.

In clinical practice, tricuspid regurgitation (TR) is a common finding and can frequently be observed during routine echocardiography—as an incidental finding or as a consequence of leading left-sided heart diseases (as secondary TR (sTR)).1 Population-based data regarding the prevalence of TR are divergent—mainly due to different (echocardiographic) classification; the Framingham Heart Study showed a prevalence of mild TR in overall >80% of the population—particularly affecting people at older age and of female gender.2 Consequently and with regard to the elderly (>70 years), a significant TR (≥moderate) was present in 1.5% of male and 5.6% of female patients, respectively.2 Thus, clinically relevant TR can be anticipated in approximately 3 million individuals in Europe and 1.5 million individuals in the USA.2–4 Moreover, prevalence of ≥moderate TR in patients with chronic heart failure and reduced left ventricular ejection fraction is even higher with approximately 26%.2 5 6 The importance of TR for prognosis has long been underrated and treatment has subsequently been neglected in accordance with the initial recommendations to handle TR with optimal heart failure therapy.4 7 8 Especially, significant sTR can long remain silent, compensated and asymptomatic, thus complicating treatment and decision making; moreover, sTR—particularly refractory sTR—stands as a marker for progressed heart failure with unfavourable outcome, high morbidity and mortality.4 6 9–11 In particular, preinterventional sTR in patients after interventional mitral valve repair only improved postinterventionally in roughly one third and persisting or even progressing sTR was simultaneously associated …

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  • Contributors All authors contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.