The current state of isolated tricuspid valve surgery: how it complements transcatheter tricuspid valve interventions

Tricuspid valve insufficiency represents a prevalent health burden for many patients worldwide but remains highly undertreated. This is especially true for isolated tricuspid disease, where surgical intervention remains underutilized. Despite historically elevated periprocedural risk, isolated tricuspid valve surgery (iTVS) today can provide an effective and reliable solution to tricuspid disease. Successful iTVS requires careful evaluation of valve anatomy, pathophysiology, and patient risk profile. Available risk calculators can be useful tools in determining patient risk and surgical candidacy. Additionally, intervening within the treatment window before late right ventricular disease and distortion with end-organ damage is integral to success. The application of minimally invasive surgical approaches can further improve outcomes. Furthermore, tricuspid valve repair has been shown to improve long-term survival. For patients who are not candidates for surgery, transcatheter modalities have increased awareness and provide a promising treatment alternative for tricuspid regurgitation (TR) reduction and symptom control, albeit with limited durability data. Currently, surgical and transcatheter interventions address separate populations with distinct risk profiles. Hence, treatment success is dependent on matching the right patient with the right procedure. Patients with suitable anatomy and lower risk profiles should be considered for surgical approaches, particularly if repair may be feasible.