Timing is everything in tricuspid regurgitation care
New minimally invasive therapies expand treatment options, but identifying the right patients before irreversible damage occurs remains critical.
When it comes to treating structural heart disease, knowing when to intervene can be just as important as knowing how. With new technologies expanding treatment options, physicians face increasingly complex decisions about which patients will benefit most, which approaches to pursue and how long they can safely wait.
These decisions will be explored at the Friday session “Lifetime Valve Care in 2026: Who to Treat, When to Intervene and Which Technology Wins?” Panelists will review current guidelines, emerging technologies and strategies for optimizing care across a patient’s life.
Abdulla Damluji, MD, PhD, MBA, and Angela Lowenstern, MD, MHS, will co-moderate the session, which will include a presentation by Samir Kapadia, MD: “Tricuspid Intervention: Who Should We Treat, and When Is It Too Late?”
Kapadia will focus on patient selection and personalized care plans for people with tricuspid regurgitation (TR). Although mild cases of TR often don’t present symptoms, more severe cases are associated with shortness of breath, extreme fatigue, peripheral swelling and abdominal bloating. Kapadia, who is chair of the department of cardiovascular medicine and holds the Jennifer and Robert McNeil Endowed Chair in Interventional Cardiology at Cleveland Clinic in Ohio, said these patients must be considered for TR intervention — and quickly.
“The timing of tricuspid regurgitation treatment is very important and not widely studied or understood,” Kapadia said. “Even when diuretics are able to control edema, one should consider TR treatment upon evidence of episodic decompensation, RV (right valve) dysfunction, increasing dose of diuretics, etc.”
Untreated patients with TR are at high risk of poor quality of life, morbidity and mortality. Traditionally, Kapadia said, clinicians have treated TR with diuretics, which only ease symptoms. However, in the past three years, the Food and Drug Administration has approved two minimally invasive tricuspid-valve surgeries.
- Transcatheter edge-to-edge repair for tricuspid regurgitation (T-TEER) uses a catheter to attach a clip that helps close the valve. In one 2023 clinical trial, T-TEER improved patient quality-of-life scores and reduced the level of TR severity. Almost every patient in the study (98.3%) who underwent T-TEER was free from major adverse events at 30 days.
- Transcatheter tricuspid valve replacement (TTVR) uses a catheter to implant a device inside the impaired tricuspid valve. According to a 2025 review paper, TTVR may improve patient quality of life, reduce TR, increase RV function and even reverse RV remodeling.
Although both procedures carry risks, such as internal bleeding, device detachment or incompatibility, their approval and integration into clinical practice have changed the game for patients with TR, Kapadia said.
One of the biggest factors in choosing a surgical approach is a patient's anatomy. Kapadia also stressed the importance of early referral for tricuspid valvesurgery.
“It is too late once severe right valve dysfunction has produced ascites,” he said. This elevated pressure in the RV can cause extreme discomfort, interfere with diuretics and lead to backward venous congestion or RV heart failure.
