ACC 2025 Expert Pathway – Practical Use of Therapies in Severe Tricuspid Regurgitation
ACC 2025 Expert Pathway – Practical Use of Therapies in Severe Tricuspid Regurgitation
(Highlighted in a medical news release in October 2025)
Keynotes :
1. Refer early to a valve team when TR is severe + symptomatic (or RV dilation/dysfunction is progressing), and after optimizing diuretics, AF control, and pulmonary HTN contributors.
2. T-TEER (e.g., TriClip) if functional/secondary TR with favourable leaflet anatomy (adequate tissue, manageable coaptation gap/tethering), preserved/moderately reduced RV, and no pacing lead prohibiting grasping.
3. TTVR (e.g., Evoque) if TEER-unsuitable anatomy (very large gap, severe tethering/multiple jets), torrential TR, lead-related TR where replacement is preferable, or failed prior TEER—provided RV function and pulmonary vascular resistance are acceptable and anticoagulation is feasible.
4. Surgery when concomitant left-sided surgery is planned, or primary/organic TR (leaflet pathology, endocarditis, trauma/Ebstein) in younger/low-risk patients where durable repair is likely.
5. Defer/avoid intervention with end-stage RV failure, severe, fixed pulmonary HTN, advanced multi-organ dysfunction, frailty/limited life expectancy, or anatomy unsuitable for both TEER/TTVR.
6. Imaging for selection: baseline TTE/TEE for mechanism/severity; CT (landing zone/annulus, leads, RV–PA geometry) especially for TTVR; CMR if RV size/function is uncertain.
7. Post-procedure care: diuretic optimization, rhythm management, RV monitoring; anticoagulation after TTVR per device/protocol and bleeding risk(anticoagulation after TTVR = usually oral anticoagulant such as warfarin or DOAC for ≈3–6 months, adjusted to bleeding risk and device protocol.) ; scheduled echo follow-up(at discharge, 1–3 months, and periodically thereafter).
