{"id":8769,"date":"2025-09-26T20:14:43","date_gmt":"2025-09-26T17:14:43","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8769"},"modified":"2025-09-26T20:14:43","modified_gmt":"2025-09-26T17:14:43","slug":"acc-2025-expert-consensus-on-severe-tricuspid-regurgitation-tr-clinical-summary","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/acc-2025-expert-consensus-on-severe-tricuspid-regurgitation-tr-clinical-summary\/","title":{"rendered":"ACC 2025 Expert Consensus on Severe Tricuspid Regurgitation (TR) \u2013 Clinical Summary"},"content":{"rendered":"
ACC 2025 Expert Consensus on Severe Tricuspid Regurgitation (TR) \u2013 Clinical Summary<\/div>\n
<\/div>\n
Source : 2025 ACC Consensus on Severe Tricuspid Regurgitation. J Am Coll Cardiol, Sept 22, 2025.<\/div>\n
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Keynotes :<\/div>\n
<\/div>\n
1. Patient Identification and Indications<\/div>\n
\u2022 Primary indication: patients with severe symptomatic TR (NYHA II\u2013IV) who remain symptomatic despite optimal medical therapy (OMT).<\/span><\/div>\n
\u2022 Most cases are secondary TR, due to:<\/span><\/div>\n
\u2022 Left-sided valve disease or heart failure.<\/span><\/div>\n
\u2022 Long-standing atrial fibrillation \u2192 right atrial enlargement and annular dilation.<\/span><\/div>\n
\u2022 Pulmonary hypertension with RV remodeling.<\/span><\/div>\n
\u2022 Pacemaker\/ICD leads: highlighted because device leads can directly cause TR by impeding leaflet motion or tethering the valve.<\/span><\/div>\n
\u2022 Compared with Mitral TEER: patient selection for tricuspid TEER is less restrictive, reflecting unmet need and safety of new catheter devices. Many TR patients may be considered even at intermediate surgical risk, unlike the stricter criteria for mitral interventions.<\/span><\/div>\n
<\/div>\n
2. Evaluation<\/div>\n
\u2022 First-line imaging: transthoracic echocardiography (TTE).<\/span><\/div>\n
\u2022 Advanced imaging (CT, MR):<\/span><\/div>\n
\u2022 Assess annular dilation (common in secondary TR).<\/span><\/div>\n
\u2022 Evaluate RV and RA size, RV systolic function, and leaflet tethering(The severity of leaflet pulling, assessed by imaging (coaptation gap), is a key determinant of TEER feasibility).<\/span><\/div>\n
\u2022 Plan for device sizing and implantation strategy.<\/span><\/div>\n
\u2022 Key concept: annular dilation is a hallmark of secondary TR but may not be present in primary TR (recognizing this mechanism guides therapy: secondary TR often treated with catheter-based repair\/replacement, while primary TR may require surgery).<\/span><\/div>\n
<\/div>\n
3. Decision-Making<\/div>\n
\u2022 Decisions are made by a multidisciplinary Heart Team (imaging specialists, interventionalists, surgeons).<\/span><\/div>\n
\u2022 Factors considered:<\/span><\/div>\n
\u2022 Symptom burden.<\/span><\/div>\n
\u2022 Surgical risk profile (low vs. intermediate vs. high).<\/span><\/div>\n
\u2022 Anatomy (annulus size, coaptation gap, RV function, presence of device leads).<\/span><\/div>\n
<\/div>\n
4. Treatment Options<\/div>\n
\u2022 Medical therapy:<\/span><\/div>\n
\u2022 Loop diuretics to manage congestion.<\/span><\/div>\n
\u2022 Control atrial fibrillation.<\/span><\/div>\n
\u2022 Manage pulmonary hypertension when possible.<\/span><\/div>\n
\u2022 Catheter-based interventions:<\/span><\/div>\n
\u2022 T-TEER (TriClip, Abbott): edge-to-edge leaflet repair.<\/span><\/div>\n
\u2022 TTVR (Evoque, Edwards): full transcatheter valve replacement.<\/span><\/div>\n
\u2022 Both devices have FDA approval (2024\u20132025) and CMS coverage in the U.S. \u2192 expanded access.<\/span><\/div>\n
\u2022 Surgery:<\/span><\/div>\n
\u2022 Reserved for lower-risk patients or those already undergoing left-sided valve surgery.<\/span><\/div>\n
\u2022 Still underused compared with aortic and mitral surgery because:<\/span><\/div>\n
1. Patients often present late with advanced RV dysfunction \u2192 outcomes are poor.<\/span><\/div>\n
2. Historically limited evidence supporting early tricuspid surgery.<\/span><\/div>\n
3. Higher operative risk due to comorbidities (HF, AF, PH).<\/span><\/div>\n
4. Traditionally performed only when combined with mitral\/aortic surgery.<\/span><\/div>\n
<\/div>\n
5. <\/span>Rapid growth of safer catheter-based options has further reduced surgical referrals.<\/div>\n
<\/div>\n
5. Special Considerations<\/div>\n
\u2022 Pacemaker leads: important cause of TR; management may involve lead revision or device-based repair\/replacement.<\/span><\/div>\n
\u2022 Cor pulmonale \/ COPD:<\/span><\/div>\n
\u2022 Not all patients with cor pulmonale qualify.<\/span><\/div>\n
\u2022 End-stage pulmonary hypertension with fixed RV failure is unlikely to benefit.<\/span><\/div>\n
\u2022 If COPD causes functional TR that is severe and symptomatic despite OMT, catheter therapy may be considered.<\/span><\/div>\n
\u2022 Post-MI (RV infarction): may result in secondary TR; intervention considered if TR remains severe and symptomatic after optimized HF\/ischemia therapy.<\/span><\/div>\n
\u2022 Elderly and frail patients: catheter-based options offer less invasive alternatives.<\/span><\/div>\n
\u2022 Right ventricular dysfunction:<\/span><\/div>\n
\u2022 Mild\u2013moderate: intervention works best before severe irreversible RV failure.<\/span><\/div>\n
\u2022 Severe but potentially reversible: suggested if RV function improves after decongestion\/afterload reduction, or if advanced imaging shows preserved contractile reserve without extensive fibrosis (e.g., cardiac MRI without late gadolinium enhancement).<\/span><\/div>\n
\u2022 Severe and irreversible: usually considered futility; outcomes are poor regardless of intervention.<\/span><\/div>\n
<\/div>\n
6. Mitral vs. Tricuspid TEER \u2013 Key Differences<\/div>\n
\u2022 Common features:<\/span><\/div>\n
\u2022 Both require persistent symptoms despite OMT, Heart Team evaluation, and suitable anatomy.<\/span><\/div>\n
\u2022 MitraClip (Mitral TEER):<\/span><\/div>\n
\u2022 Primary MR: indicated for high\/prohibitive surgical risk.<\/span><\/div>\n
\u2022 Secondary MR: requires strict COAPT-like criteria (LVEF 20\u201350%, LVESD \u226470 mm, PASP \u226470 mmHg, central jet).<\/span><\/div>\n
\u2022 Strong evidence for reduced HF hospitalizations and mortality.<\/span><\/div>\n
\u2022 TriClip (Tricuspid TEER):<\/span><\/div>\n
\u2022 Indicated for severe symptomatic TR (usually secondary) despite OMT.<\/span><\/div>\n
\u2022 Fewer anatomic and functional restrictions compared with MitraClip.<\/span><\/div>\n
\u2022 Considered in patients with intermediate or high surgical risk, not just prohibitive risk.<\/span><\/div>\n
\u2022 Clinical benefit is mainly symptom relief and improved functional capacity; survival benefit less established than in mitral disease.<\/span><\/div>\n
<\/div>\n
7. Follow-Up<\/div>\n
\u2022 Clinical monitoring: symptoms, exercise tolerance, quality of life.<\/span><\/div>\n
\u2022 Imaging: periodic echocardiography \u00b1 CT\/MR to assess residual TR, RV function, and device durability.<\/span><\/div>\n
\u2022 Lifelong surveillance is required as the field and devices continue to evolve.<\/span><\/div>\n
<\/div>\n
8. Key Clinical Takeaways<\/div>\n
1. Indication: severe symptomatic TR despite OMT \u2192 catheter therapy should be considered.<\/span><\/div>\n
2. Secondary TR is the main target group (left-sided disease, AF, pulmonary hypertension).<\/span><\/div>\n
3. Pacemaker\/ICD leads are a recognized cause and require special evaluation.<\/span><\/div>\n
4. Annular dilation is central to secondary TR and must be measured for planning.<\/span><\/div>\n
5. Criteria for TriClip\/TTVR are less restrictive than for MitraClip; even intermediate-risk patients may qualify.<\/span><\/div>\n
6. Not all cor pulmonale\/COPD qualify; interventions are reasonable only when TR itself is severe and symptomatic, not when PH is end-stage.<\/span><\/div>\n
7. Surgery is underused due to late referral, high operative risk, and the rise of catheter alternatives.<\/span><\/div>\n
8. TEER\/TTVR mainly improve symptoms and function; survival benefit is stronger in mitral disease.<\/span><\/div>\n
<\/div>\n
<\/div>\n
https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2025.07.002<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

ACC 2025 Expert Consensus on Severe Tricuspid Regurgitation (TR) \u2013 Clinical Summary Source : 2025 ACC Consensus on Severe Tricuspid Regurgitation. J Am Coll Cardiol, Sept 22, 2025. Keynotes : 1. Patient Identification and Indications \u2022 Primary indication: patients with severe symptomatic TR (NYHA II\u2013IV) who remain symptomatic despite optimal medical therapy (OMT). \u2022 Most […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8769","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8769","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8769"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8769\/revisions"}],"predecessor-version":[{"id":8770,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8769\/revisions\/8770"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8769"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8769"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8769"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}