Three decades evolution of the lifetime management approach to tricuspid valve disease: a multidisciplinary European perspective from a high-volume heart valve center

Background: The treatment of tricuspid valve (TV) disease has increased over the last decades. This study evaluates trends, patient characteristics, and outcomes of surgical and transcatheter TV interventions over
30 years.
Methods: All consecutive adult patients undergoing TV surgery or transcatheter intervention at the Heart Center Leipzig were included in this unadjusted descriptive analysis. Patients with TV endocarditis were excluded. Surgical data covered 1996–2024, transcatheter edge-to-edge repair (T-TEER) 2016–2024, and transcatheter TV replacement (TTVR) 2021–2025. All information was obtained from the institutional database.
Results: A total of 982 patients were analyzed: 450 (46%) surgical, 498 (51%) T-TEER, and 34 (3%) TTVR patients. Surgical patients were younger (67 vs. 79 vs. 81 years, respectively, P<0.001) and had fewer comorbidities than those treated interventionally. Higher-grade TR was more common in T-TEER and TTVR cohorts. Device leads crossing the TV were present in 109 (24%) surgical, 147 (30%) T-TEER, and seven (21%) TTVR patients (P=0.13). Reoperations accounted for 165 (37%) surgical cases, while prior cardiac operations were documented in 148 (30%) T-TEER and 7 (21%) TTVR patients. Surgery after T-TEER was infrequent (n=4, 1%). One-year survival was 88% after surgery, 83% after T-TEER, and 94% after TTVR (log-rank P=0.036). Among surgical patients, 335 (74%) did not require any re-hospitalizations during the first year postoperatively. Surgical reoperations showed survival comparable to primary procedures (actuarial survival at 9 years, 55% vs. 59%, respectively; log-rank P=0.07). Surgical TV replacement was associated with worse survival than surgical TV repair (at 9 years. 55% vs. 65%, respectively; log-rank P=0.03).
Conclusions: Surgical TV repair yields better outcomes than replacement. Long-term survival after reoperation parallels that of primary TV surgery. Surgical and transcatheter therapies address distinct patient populations. Multidisciplinary heart team evaluation remains essential for optimal management of TV disease.