The role of staging right heart failure in management of secondary tricuspid regurgitation.

Once considered "benign", secondary tricuspid regurgitation (sTR) as a consequence of left-sided heart disease or pulmonary hypertension is both frequent and prognostically important. However, severe sTR is under-treated, as it may remain asymptomatic for an extended period and may lead to irreversible right ventricular (RV) and end-organ damage. Existing guideline recommendations tend to be conservative, often suggesting intervention late, which stems largely from the high mortality risk associated historically with tricuspid valve (TV) surgery. Over time, this results in right heart failure (RHF) and increases the mortality risk associated with intervention. Similar to left heart failure, RHF is a progressive condition that can be classified into stages. As such, a similar staging system, that incorporates both RV remodelling and the clinical manifestations of RHF has been proposed for risk stratification of these patients, and it may be helpful in guiding the optimal timing for intervention in asymptomatic severe TR.