Rescuing the "Forgotten Valve": Clinical Outcomes and Procedural Innovations in Transcatheter Tricuspid Edge-to-Edge Repair

Review Paper | 2026 | Volume 2 | Issue 1 | Page 15-24

1. Dr. Ibrahim Kureshy, Lecturer, Cardiology, DMCH-UAE

2. Dr. Rabia Fatima, Lecturer, Cardiology, DMCH-UAE

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Abstract

Background: For decades, tricuspid regurgitation (TR) was relegated to the status of the "forgotten valve," often managed conservatively until the onset of irreversible right heart failure. However, the 2024–2026 clinical landscape has been redefined by the success of Transcatheter Tricuspid Edge-to-Edge Repair (T-TEER). This review evaluates the clinical outcomes, anatomical hurdles, and recent procedural innovations that have established T-TEER as a safe and effective alternative to high-risk surgical intervention. Methods: We synthesized data from the TRILUMINATE Pivotal Trial three-year follow-up and the bRIGHT and TriClip real-world registries. The analysis focuses on the evolution of dedicated tricuspid delivery systems (e.g., TriClip G4 and Pascal Ace/P10) designed specifically to navigate the unique challenges of the right heart: thin leaflet tissue, large coaptation gaps, and the presence of pacemaker leads. Results: The 2026 data confirm that T-TEER achieves a reduction to $\leq$ Moderate TR in over 85% of cases, with significant improvements in the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and New York Heart Association (NYHA) functional class. Recent procedural innovations, including independent leaflet grasping and simultaneous multi-planar 3D transesophageal echocardiography (TEE), have reduced procedural times by 30% and improved the durability of the repair. Furthermore, the "Predictive Modeling" of the right ventricular-pulmonary arterial (RV-PA) coupling has allowed for better patient selection, identifying those most likely to benefit before the onset of refractory venous congestion. Discussion: The "Rescuing" of the tricuspid valve represents a paradigm shift toward early intervention. While T-TEER is not a "one-size-fits-all" solution—particularly in cases of extreme annular dilation or severe leaflet tethering—it has demonstrated superior safety compared to surgery and superior quality-of-life outcomes compared to medical therapy alone. As we move toward 2030, this review concludes that T-TEER is no longer an experimental "rescue" therapy but a cornerstone of the Comprehensive Heart Team approach to valvular heart disease.