Tricuspid valve edge to edge repair vs replacement - a comparative analysis and future directions

Sep 29, 2026

Tricuspid regurgitation (TR) is a common but underrecognized valvular disease linked to substantial morbidity and mortality. This review compares transcatheter edge-to-edge repair (T-TEER) using the TriClip device and transcatheter tricuspid valve replacement (TTVR) using the EVOQUE device for severe symptomatic TR, emphasizing safety, procedural factors, and clinical outcomes. TR management is challenging due to valve anatomy, frequent lead interference, and comorbid RV dysfunction, atrial fibrillation, and pulmonary hypertension.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Methods

Search strategy and selection criteria

Further sections

FUTURE CARDIOLOGY 2026, VOL. 22, NO. 1, 75–86 [https://doi.org/10.1080/14796678.2025.2545133](https://doi.org/10.1080/14796678.2025.2545133) REVIEW Tricuspid valve edge to edge repair vs replacement – a comparative analysis and future directions Joseph Hajja, Joseph Kassabb, Ziad Zalaquetta, Serge C. Harba and Samir R. Kapadiaa aHeart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA; bDepartment of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA ABSTRACT Tricuspid regurgitation (TR) is a common yet underrecognized valvular disease associated with significant morbidity and mortality. Recent advances in transcatheter therapies, namely transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott) and transcatheter tricuspid valve replacement (TTVR) with the EVOQUE device (Edwards Lifesciences), offer promising alternatives to surgery for severe symptomatic TR. This review compares both approaches with a focus on safety, procedural considerations, and clinical outcomes. Treating TR remains uniquely challenging due to the anatomical complexity of the valve, frequent lead interference, and common coexistence of RV dysfunction, atrial fibrillation, and pulmonary hypertension. Many affected patients are elderly and frail, rendering them poor surgical candidates. Optimal treatment requires individualized decision-making guided by detailed imaging and assessment of RV function and valvular anatomy. Both therapies achieve significant TR reduction, yet each carries distinct risks: TTVR is associated with higher rates of pacemaker implantation, bleeding, and RV failure, while T-TEER may lead to single leaflet device attachment (SLDA), leaflet injury, or residual TR. Careful patient selection is essential. Despite encouraging short-term outcomes, longterm data are needed to determine survival benefit and durability. Further studies are warranted torefine technique and optimize candidate selection. ARTICLE HISTORY Received 19 May 2025 Accepted 5 August 2025 KEYWORDS TriClip; EVOQUE; transcatheter edge-to-edge repair (TEER); transcatheter tricuspid valve replacement (TTVR); tricuspid regurgitation; tricuspid annulus; right ventricular function 1. Introduction Tricuspid regurgitation (TR) is common and associated with significant morbidity and mortality [1]. Isolated surgery on the tricuspid valve remains rare, primarily due to its high risk, with previous research indicating an in-hospital mortality ranging from 8.8% to 37%, and a five-year mortality rate reaching up to 55%[2–5]. Of note, patients with severe TR are typically elderly and have numerous comorbidities, which further elevate their surgical risk. This has led to many patients with severe TR either remaining untreated or receiving only medical treatment, both of which are associated with increased mortality and morbidity [6,7]. The cumulative mortality rate for individuals with untreated severe tricuspid regurgitation (TR) from any cause is approximately 30% at one year, 50% at two years, and 70% at four years after diagnosis [8]. Additionally, the prevalence of severe TR increases with age, reaching up to 4.0% in individuals over 75 years old [9, 10]. To address this clinical challenge, several transcatheter tricuspid valve interventions (TTVI) have been developed recently, demonstrating encouraging outcomes in preliminary trials [11, 12]. Notably, landmark clinical trials such as TRILLUMINATE Pivotal for tricuspid edge-to-edge repair using TriClip (Abbott), and TRISCEND II for tricuspid valve replacement with the EVOQUE (Edwards Lifesciences) device have shown promising results in the management of TR [13, 14]. Both the TriClip and EVOQUE devices have received FDA approval for clinical use in patients with severe symptomatic tricuspid regurgitation (TR) who are on appropriate medical therapy. Both the TriClip and the EVOQUE systems are approved for patients at high

FAQs

Why is treating severe tricuspid regurgitation particularly challenging?

It is difficult because of complex valve anatomy, frequent lead interference, and the frequent co-occurrence of RV dysfunction, atrial fibrillation, and pulmonary hypertension.

What are the two transcatheter approaches compared in the review?

The review compares transcatheter edge-to-edge repair (T-TEER) with the TriClip device and transcatheter tricuspid valve replacement (TTVR) with the EVOQUE device.

How do safety risks differ between TTVR and T-TEER?

TTVR is associated with higher pacemaker implantation, bleeding, and RV failure rates, while T-TEER may cause single leaflet device attachment (SLDA), leaflet injury, or residual TR.

Sep 29, 2026

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