Tricuspid annuloplasty: a piece of the puzzle or the whole picture?

Tricuspid regurgitation (TR) is a prevalent disease commonly secondary to left heart disease or longstanding atrial fibrillation. Patients with severe TR suffer from high morbidity and mortality rates, and renal, hepatic and bleeding disorders. The burden of these comorbidities, along with the TR itself, renders these patients at high risk, especially with regard to surgical treatment of TR. In addition, it remains undetermined whether improvement of TR significantly impacts meaningful clinical endpoints such as mortality and heart failure hospitalisation. These uncertainties make high demands on any putative attempt at TR treatment. In an ideal world, such a strategy should (1) carry zero periprocedural mortality and demonstrate high safety, (2) be efficient in TR reduction, (3) be truly minimally invasive with low access site complications, (4) enable early mobilisation and discharge, (5) not increase the already increased bleeding or thromboembolic event rate, (6) leave open future additional treatment options in case of residual or recurrent TR, and (7) address the pathology leading to TR.

Unfortunately, the targeted patient population is highly variable due to changing comorbidities, and the anatomical and functional components...