TTVR Versus T-TEER in Treating Tricuspid Regurgitation With Stephen Landers, MD

Tricuspid Transcatheter Edge-to-Edge Repair (T-TEER) and Transcatheter Tricuspid Valve Replacement (TTVR), 2 new therapies for reducing tricuspid regurgitation (TR), have emerged as safe and effective methods of managing this significant predictor of mortality and morbidity in patients with heart failure (HF).1

TTVR involves inserting an anchoring mechanism via the transfemoral or transjugular venous access, which attaches the delivery system to the mitral valve. The attached catheter then carries a compressed replacement tricuspid valve into the heart. TTVR is typically reserved for elderly patients with severe tricuspid valve disease who are considered poor candidates for open-heart surgery.2

T-TEER is a similar procedure, although the catheter is inserted through the femoral vein. Unlike the plethora of devices applicable in TTVR, T-TEER specifically uses the TriClip, a mechanism with 2 arms to capture and lock valve leaflets. Initially designed as the MitraClip by Abbott, it was adapted to TR treatment, leading the company to develop the TriClip specifically for TR.3

In a presentation at the 42nd Annual Echocardiography and Structural Heart Symposium in Coral Gables, Florida, Stephen Little, MD, a cardiologist with Houston Methodist DeBakey Heart & Vascular Center and program director of the Cardiovascular Fellowship, discussed the differences between the 2 treatments, when each can be implemented, and how clinicians can manage patients’ – and their own – expectations given the promising nature of these new procedures.1

The editorial team at HCPLive sat down with Little to discuss the implications presented by T-TEER and TTVR for patients with various cardiovascular impairments and diseases, as well as the practical guidelines and limitations for diagnosing patients with TR and choosing the correct therapy.

Little noted the wide anatomic spectrum which determines how patients with TR can be treated and the risks and limitations included with both procedures.

“At 1 end of the spectrum, a T-TEER makes perfect sense; at the other end of the spectrum, T-TEER is just impossible,” Little told HCPLive. “And then you have therapies like TTVR valve implantation. So the first real discussion point is, does the anatomy allow both procedures? And often it doesn’t.”

Despite successful trials and the effectiveness of the treatment, both T-TEER and TTVR have notable limitations. First, both are approved only for a disease that is notoriously difficult to diagnose, as well as being commonly known as a “forgotten disease” due to a significant lack of treatment innovation. Additionally, patients must have suitable anatomy and sufficient imaging quality via transesophageal echocardiography.2

Little explained the struggle of diagnosing TR, given its shared symptoms with a variety of other diseases – and with simply aging.

“What defines a symptom for TR? In some people, it’s a manifestation of liver dysfunction which is their first sign, and in some people it’s just a little bit of fatigue,” Little told HCPLive. “But, as the saying goes, you only grow old once, so you don’t have something to compare it to. So, is your fatigue because you’ve had 70 birthdays, or because you have TR? And these aren’t easy things to resolve.”

References

1. Little S. TTVR vs. T-TEER: Balancing Excitement with Practicality for the General Cardiologist. Presented at the 42nd Annual Echocardiography and Structural Heart Symposium. Coral Gables, Florida. September 26-27, 2025.

2. Hausleiter J, Stolz L, Lurz P, et al. Transcatheter Tricuspid Valve Replacement. J Am Coll Cardiol. 2025;85(3):265-291. doi:10.1016/j.jacc.2024.10.071

3. Hao Q, Horton J; Authors. Transcatheter Edge-To-Edge Valve Repair for Tricuspid Regurgitation: CADTH Health Technology Review [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2023 Aug. Available from: https://www.ncbi.nlm.nih.gov/books/NBK596754/