The American College of Cardiology (ACC) recently released an expert consensus decision pathway featuring ten elements of tricuspid regurgitation (TR) treatment that are intended to enable clinicians to better improve care for patients with severe TR, particularly secondary TR, from evaluation through treatment. Overall, the consensus writing committee endorses the evidence-based approach to evaluating and managing patients with TR, as recommended in the 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease.

The expert consensus concludes with ten key elements that are summarized below.

10 Key Elements of the 2025 ACC Statement Regarding the Treatment of TR:
  1. Screening: Clinicians can screen for TR early by anticipating its development in the context of left-sided heart disease, atrial fibrillation, pulmonary hypertension, or after cardiac implantable electronic device placement; by assessing the venous wave form during a physical examination; and by incorporating the findings from transthoracic echocardiography that may have been performed for another indication.
  2. Defining: Clinicians should define the mechanism, severity, and etiology of TR with transthoracic echocardiography as the preferred initial imaging modality.
  3. Applying: Clinicians should apply indications for advanced imaging and selectively use cardiac catheterization to augment characterization of TR severity. 
  4. Managing: Clinicians should manage left-sided heart disease with guidance-directed and intervention when indicated for heart failure, valvular heart disease, atrial fibrillation, and pulmonary hypertension.
  5. Incorporating: Clinicians should incorporate a patient’s natural history of TR and consider referrals to specialists in certain situations. 
  6. Recognizing: Clinicians should recognize the indications for referral to MDT for consideration of surgical or transcatheter TV intervention.
  7. Anticipating: Clinicians should anticipate issues related to CIED management before and after TV intervention, along with recognizing potential hazards with CIED lead extraction.
  8. Counseling: Clinicians should counsel patients on potential risks and benefits surrounding TV surgery and available TTVIs.
  9. Designing: Clinicians should design strategies for evaluation and treatment with notable attention to medical, rhythm, device, and anti-coagulant management.
  10. Establishing: Clinicians should establish care and treatment goals when TV intervention is considered inappropriate or not feasible.

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