The Tricuspid Valve — The Forgotten Valve

The tricuspid valve sits between the right atrium and right ventricle and controls blood flow from the body back into the lungs. For decades, severe tricuspid regurgitation (TR) — where the valve leaks significantly — was considered a marker of advanced disease rather than a treatable condition. Surgery on the tricuspid valve carries high risk, and many patients were denied treatment due to advanced age or comorbidities.

Transcatheter tricuspid therapies have fundamentally changed the treatment landscape for severe TR. Devices like TriClip and Evoque now offer meaningful symptom relief and TR reduction for patients who previously had no good options.

Transcatheter Tricuspid Edge-to-Edge Repair (T-TEER) — TriClip

TriClip (Abbott) works on the same principle as MitraClip — a clip is placed on the tricuspid valve leaflets to reduce regurgitation by creating a double-orifice valve. It is delivered via a catheter through the femoral vein under general anesthesia and 3D TEE guidance. Multiple clips can be placed to achieve optimal TR reduction.

TRILUMINATE Pivotal (TCT 2024, 2-year data confirmed at EuroPCR 2025) demonstrated sustained quality of life improvement and TR reduction with TriClip. While no survival benefit was shown in the RCT, the clinical improvement — reduced hospitalizations, better functional capacity, improved symptoms — was substantial and durable at 2 years.

Transcatheter Tricuspid Valve Replacement — Evoque

For patients with more complex tricuspid anatomy not suitable for repair, the Evoque system (Edwards Lifesciences) provides full transcatheter tricuspid valve replacement. TRISCEND II (TCT 2024) was the pivotal RCT comparing Evoque to medical therapy — it demonstrated significant QoL improvement, TR elimination, and functional benefit, establishing TTVR as a viable treatment for patients who cannot undergo repair or surgery.

Key Clinical Trial Evidence

TRILUMINATE PivotalTriClip T-TEER: sustained QoL improvement and TR reduction at 2 years — TCT 2024
TRISCEND II (NEJM 2024)Evoque TTVR vs. medical therapy: significant QoL and functional benefit — practice-changing
EuroPCR 2025 BundleTRI-SCORE validated, FATE registry, bRIGHT real-world data — all confirm durable TR reduction
ACC 2026 — TRI-FR 2yr2-year TRI-FR tricuspid TEER follow-up data presented

Frequently Asked Questions

How is the right anatomy for TriClip vs. Evoque determined?

Complex anatomy (severe annular dilation, multiple prolapsing leaflets, very large coaptation gap) tends to favor replacement over repair. A detailed TEE and CT analysis determines which approach is most appropriate — this is a heart team decision made case-by-case.

Does tricuspid repair cure heart failure?

TR is often a consequence of underlying conditions — heart failure, AF, pulmonary hypertension, or left heart disease. Treating TR improves symptoms and reduces hospitalizations but does not cure the underlying condition. Managing the primary cardiac disease alongside TR repair is essential.

Is there a risk of making TR worse with TriClip?

In experienced hands, TriClip failure requiring conversion to another therapy is uncommon. Careful patient selection, 3D TEE guidance, and clip positioning strategy minimize the risk of suboptimal outcomes.