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Transcatheter TR Interventions — EECC MCQ

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ModerateHeart FailureTranscatheter TR InterventionsEECC

A 70-year-old man with HFrEF is found to have severe functional TR with progressive RV dilatation and dysfunction. He is not a surgical candidate. What transcatheter options exist for severe TR?

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Correct answer: ATranscatheter edge-to-edge repair (TEER, TriClip) for TR has shown symptom improvement in registries and the TRILUMINATE trial; transcatheter TV replacement (EVOQUE) is an emerging alternative — both are Class IIb options at experienced centres for inoperable symptomatic severe TR

Transcatheter tricuspid valve interventions are rapidly evolving: (1) TEER for TR (TriClip/MitraClip adapted for TV): grasps the tricuspid leaflets to improve coaptation; the TRILUMINATE Pivotal trial (2023) showed significant TR reduction and symptom improvement vs medical therapy at 1 year; (2) transcatheter TV replacement (EVOQUE, GATE): completely replaces the valve — earlier-stage development but promising results in compassionate use; (3) annuloplasty devices (Cardioband): percutaneous annular reduction; (4) coaptation devices (FORMA, PASCAL). The 2025 ESC VHD Guidelines position transcatheter TV interventions as Class IIb: for symptomatic severe TR in patients at high surgical risk, at experienced centres, ideally within clinical trials or registries. Patient selection is critical: RV function must be sufficient to tolerate the procedure and benefit from reduced TR. Advanced RV failure may preclude benefit.

Reference: ESC/EACTS (2025): VHD Guidelines; TRILUMINATE Trial