Rochester, Minnesota · United States
cardiac surgeon
Joseph A. Dearani →
Dearani’s surgical practice includes Ebstein anomaly and congenital tricuspid-valve reconstruction at Mayo.
Sources: Mayo Clinic · Joseph Dearani
Tricuspid valve disease · Decision guide
Tricuspid valve disease: repair, replacement and catheter options
Understand the cause and severity of a tricuspid leak, when to compare surgery with catheter treatment, and why right-heart function matters.
At a glance
Tricuspid treatment depends on leakage or narrowing, symptoms and right-heart function. Medicines relieve congestion; surgical or catheter treatment can address the valve in selected patients.
A mild leak may need no procedure
More significant disease is assessed alongside right-ventricular function, lung pressures and contributing conditions.
Sources: Tricuspid valve regurgitation: diagnosis and treatment
Catheter treatment still has risks
Tricuspid replacement can improve patient outcomes but serious bleeding and permanent pacing occurred in the FDA evidence.
Sources: EVOQUE transcatheter tricuspid replacement: FDA approval overview
Another valve operation changes the decision
The 2025 European guidance includes concomitant treatment of severe tricuspid regurgitation during left-sided valve surgery.
Sources: 2025 ESC/EACTS valvular heart disease guideline: official recommendation slides
Find a tricuspid valve specialist
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Benefits and trade-offs
Potential advantages
- Surgical repair can preserve a suitable valve, while catheter options extend treatment to selected patients at high surgical risk.
Sources: 2025 ESC/EACTS valvular heart disease guideline: official recommendation slides · Tricuspid valve repair and replacement
Trade-offs and limits
- Advanced right-ventricular dysfunction, pulmonary vascular disease and unsuitable leaflet anatomy can limit benefit or feasibility.
Sources: 2025 ESC/EACTS valvular heart disease guideline: official recommendation slides
A small leak and advanced right-heart disease need different answers
A trace or mild leak may need no procedure. With more important regurgitation, the assessment includes right-heart size and pumping function, lung pressures, congestion and related heart disease.
Leakage can arise from diseased leaflets or enlargement of the chambers and valve ring. Pacemaker leads, left-sided valve disease and atrial fibrillation can contribute. Repair or replacement must address that mechanism to work.
Sources: Tricuspid valve regurgitation: diagnosis and treatment · 2020 ACC/AHA valve guideline: mitral stenosis and tricuspid disease
What each treatment is trying to do
| Treatment | Potential benefit | Limitation |
|---|---|---|
| Medicines | Reduce congestion and manage contributing disease | Do not mechanically repair a leaking valve |
| Surgical repair | Preserve the native valve | Requires a feasible durable reconstruction |
| Surgical replacement | Treat an inadequately repairable valve | Introduces prosthesis-related long-term care |
| Tricuspid TEER | Reduce regurgitation with catheter-delivered leaflet clips | Requires suitable leaflet anatomy; residual leakage can remain |
| Catheter replacement | Replace a valve without conventional surgical access in selected patients | Anatomy, device availability and procedural risk restrict eligibility |
Sources: Tricuspid valve regurgitation: diagnosis and treatment · Tricuspid valve repair and replacement · EVOQUE transcatheter tricuspid replacement: FDA approval overview
Do not leave referral until only the valve grade is considered
The 2025 European guideline supports considering catheter treatment for symptomatic severe regurgitation despite optimal medical therapy in patients at high surgical risk, without severe right-ventricular dysfunction or pre-capillary pulmonary hypertension. Suitability still depends on anatomy and specialist assessment.
When left-sided valve surgery is planned, severe tricuspid regurgitation generally calls for treatment during the same operation; repair should also be considered for moderate regurgitation. This can address both valve problems in one surgical admission.
Sources: 2025 ESC/EACTS valvular heart disease guideline: official recommendation slides
If the report says tricuspid stenosis
Stenosis restricts blood entering the right ventricle and may coexist with leakage. It needs a separate discussion from clip treatment for regurgitation. Severe symptomatic stenosis, or severe stenosis during a left-sided valve intervention, is a surgical indication in the 2025 European guidance.
Balloon treatment can widen selected narrowed tricuspid valves; associated leakage and valve anatomy can make surgery more appropriate. Congenital conditions such as Ebstein anomaly and tricuspid atresia follow their own specialist pathways.
Sources: 2025 ESC/EACTS valvular heart disease guideline: official recommendation slides · Tricuspid valve disease: diagnosis and treatment · Tricuspid valve repair and replacement
A better scan is one outcome; feeling and living better are others
Reduced leakage on a scan, better daily function, fewer admissions and longer survival are separate outcomes. FDA evidence for EVOQUE describes benefits alongside serious early complications, including bleeding and permanent pacing.
Right-ventricular function, pulmonary pressures and kidney or liver disease affect the balance of benefit and risk. A catheter procedure does not eliminate major cardiac risks.
Sources: EVOQUE transcatheter tricuspid replacement: FDA approval overview · Tricuspid valve repair and replacement · Tricuspid valve regurgitation: diagnosis and treatment
Specialists for this treatment pathway
Explore each specialist’s clinical focus, current programme and the studies relevant to this treatment. The listed roles include cardiac surgeons and, where appropriate, interventional cardiologists.
New York · United States
interventional cardiologist
Susheel K. Kodali →
Kodali is an NYU interventional cardiologist specialising in catheter valve therapies, including tricuspid treatment. His trial work examines symptoms and quality of life alongside bleeding and pacemaker risks.
Sources: Susheel K. Kodali, MD — physician profile · NYU welcomes Susheel Kodali to lead interventional cardiology · Transcatheter Valve Replacement in Severe Tricuspid Regurgitation.
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