A new multisociety Expert Consensus Systems of Care document provides operator and institutional recommendations and requirements for tricuspid interventions. Published in JACC, the document provides guidance on implementing and maintaining a transcatheter tricuspid valve intervention (TTVI) program in a rapidly evolving field.

Specifically, the document focuses on a TTVI program for treating native-valve severe tricuspid regurgitation (TR) using current U.S Food and Drug Administration (FDA)-approved devices for this indication. It provides recommendations on the knowledge base, skills and structure necessary for an effective multidisciplinary team. It also stresses the importance of shared decision-making with TR patients, who typically have advanced heart failure, atrial fibrillation and numerous comorbidities.

Facility and institutional requirements, outcome requirements and national registry requirements are also key components of the report. "TTVIs can be complex and require careful planning," say Writing Group Chair Patrick T. O'Gara, MD, MACC; Vice Chair Stephen H. Little, MD, FACC, et al. "Rigorous data collection and comparative analysis, inclusive of functional status and [quality of life] indicators, will be essential to validate the appropriateness of the continued growth in procedural volumes."

The authors acknowledge the report is likely an evolving document, given that further advances in patient selection, equipment and both interventional and surgical techniques will likely require additional guidance. However, they also note that the "guiding principles and foundational elements included in [the] document constitute an enduring commitment to optimizing patient outcomes while acknowledging the need for equitable access."

Additionally, they note that the document does not address the use of valve-in-valve and valve-in-ring. However, it is "reasonable to assume" that a well-functioning multidisciplinary team performing TTVI would also consider these therapies when appropriate, they write.

The Expert Consensus Systems of Care document is a joint report from the ACC, the American Heart Association, the American Society of Echocardiography, the Heart Rhythm Society, and the Society of Thoracic Surgeons.