In common conditions like atrial fibrillation or pulmonary hypertension, the tricuspid valve can also be compromised and not close adequately. This tricuspid valve regurgitation (TR) allows blood to flow back into the right atrium, leading to increased fluid and congestion. Patients with TR require diuretics to manage the fluid overload, but medical therapy isn’t always sufficient for patients with severe TR.

“For many years, there’s been this gap in treatment options: medical therapy can alleviate the symptoms but doesn’t address the underlying problem,” says Duke structural cardiologist Andrew Wang, MD. “Now there are procedures that are less invasive than heart surgery being developed and approved to treat patients who have refractory TR.” One of these FDA-approved options, Wang says, is transcatheter edge-to-edge repair (TEER) with devices such as TriClip (Abbott, Santa Clara, CA). 

The TEER procedure was initially developed to repair the mitral valve. “Once that technology was developed,” Wang says, “it lends itself to considering use in the tricuspid valve, which is more challenging, with three leaflets instead of two.” 

As a transcatheter procedure, inserting the TriClip requires only a small incision to access the femoral vein. The patient is under general anesthesia, and a transesophageal echo is used to guide the clip device to the tricuspid valve. A clip is placed on two of the three flaps of the tricuspid valve to improve its closure and address large gaps between the leaflets that would lead to TR.

Duke performed its first TriClip procedures in September 2024. “Most of the studies that have evaluated the transcatheter procedure have found that in comparison to continued medical therapy alone, tricuspid valve TEER or replacement significantly improves quality of life,” Wang says. After this procedure, patients typically recover and see noticeable improvement quickly.

Mild or moderate TR usually doesn’t require surgical or transcatheter intervention, Wang says. Even severe TR may not need surgery: “Patients who have severe TR with symptoms or with evidence of right ventricular dysfunction should be considered for intervention,” Wang says.

TR commonly co-occurs with other heart conditions including heart failure. “Because the majority of cases of severe TR are secondary,” Wang says, “there may be some other primary problem with the heart. At Duke, we have very strong heart failure expertise as well as cardiac surgical expertise to address those other left-sided heart problems that may be contributing to the TR.” Ranked by U.S. News and World Report as a Top 25 hospital in cardiology, Duke is also equipped with advanced cardiac imaging—including echocardiography and cardiac MRI—and multidisciplinary teams to determine the most appropriate treatment options to treat severe tricuspid valve disease.