Tricuspid valve insufficiency Position paper of the DGK

In the majority of cases patients with high-grade tricuspid valve insufficiency (TI) represent a high-risk population and the treatment is particularly complex. Therefore, selection of an appropriate therapeutic pathway for affected individuals first requires precise characterization of the genesis of the vitium. This includes transthoracic and transesophageal echocardiography, right heart and left heart catheterization and additional imaging by CT and MRI as needed. Treatment requires interdisciplinary discussion, including optimization of drug treatment for left heart failure, discussion of antiarrhythmic treatment procedures for atrial genesis of TI, exclusion of pathologies of the heart requiring surgical treatment, and exclusion of indications for targeted therapy for pulmonary arterial hypertension (PAH). Interventional treatment now has an important place, particularly because of the very frequent comorbidity of patients. The 2021 ESC guidelines recommended catheter-based reconstruction for the first time. The still limited experience with this complex form of treatment, the lack of randomized prospective studies on its effectiveness, and challenges in periprocedural imaging have prompted the DGK to formulate these recommendations in anticipation of concrete criteria for future center certification when providing a program for interventional treatment of tricuspid regurgitation. This paper is intended to contribute to the provision of this important treatment to patients in Germany under the premise of the best possible quality.

Automated summary

Patients with high-grade tricuspid valve insufficiency require precise characterization and interdisciplinary discussion for appropriate treatment. Catheter-based intervention plays an important role, but further research and standardization are needed due to the complexity and challenges involved.