Tricuspid regurgitation management: a systematic review of clinical practice guidelines and recommendations.

Ricci F; Bufano G; Galusko V; Sekar B; Benedetto U; Awad WI; Di Mauro M;
Gallina S; Ionescu A; Badano L; Khanji MY

European Heart Journal Quality of Care & Clinical Outcomes. 8(3):238-248,
2022 May 05.

Tricuspid regurgitation (TR) is a highly prevalent condition and an
independent risk factor for adverse outcomes. Multiple clinical guidelines
exist for the diagnosis and management of TR, but the recommendations may
sometimes vary. We systematically reviewed high-quality guidelines with a
specific focus on areas of agreement, disagreement, and gaps in evidence.
We searched MEDLINE and EMBASE (1 January 2011 to 30 August 2021), the
Guidelines International Network International, Guideline Library,
National Guideline Clearinghouse, National Library for Health Guidelines
Finder, Canadian Medical Association Clinical Practice Guidelines
Infobase, Google Scholar, and websites of relevant organizations for
contemporary guidelines that were rigorously developed (as assessed by the
Appraisal of Guidelines for Research and Evaluation II tool). Three
guidelines were finally retained. There was consensus on a TR grading
system, recognition of isolated functional TR associated with atrial
fibrillation, and indications for valve surgery in symptomatic vs.
asymptomatic patients, primary vs. secondary TR, and isolated TR forms.
Discrepancies exist in the role of biomarkers, complementary multimodality
imaging, exercise echocardiography, and cardiopulmonary exercise testing
for risk stratification and clinical decision-making of progressive TR and
asymptomatic severe TR, management of atrial functional TR, and choice of
transcatheter tricuspid valve intervention (TTVI). Risk-based thresholds
for quantitative TR grading, robust risk score models for TR surgery,
surveillance intervals, population-based screening programmes, TTVI
indications, and consensus on endpoint definitions are lacking.