Functional Tricuspid Regurgitation - Parameters for Patient Selection and Choice of Transcatheter Repair Method

Secondary tricuspid regurgitation (TR) is a frequent valve disease, in which symptoms typically occur at advanced stages of disease. TR impairs clinical outcome and perioperative mortality in patients with isolated TR remains high, fostering the enormous development of catheter-based tricuspid therapies witnessed throughout the last years. In this context, patient selection based on anatomical and clinical criteria, which both exhibit a large variability has gained increased attention. Prognostically, (pre-capillary) pulmonary hypertension and advanced right heart dysfunction are considered to be of major relevance. In addition, comorbidities are usually highly prevalent and the risk of futility has to be taken into account. Morphologically, tricuspid annular dilatation caused by right atrial and ventricular dilatation is the dominant mechanism of TR followed by tricuspid leaflet tethering. The extent of annular dilatation, leaflet tethering, severity of TR but also pacemaker leads are the most important morphological factors to be evaluated during echocardiographic screening.