Secondary tricuspid regurgitation (TR) has long been considered a benign and well-tolerated valvular lesion that resolves after treatment of the underlying disease. This view has been challenged by data indicating that long-standing TR can be a progressive disorder, contributing to right ventricular failure and end-organ damage, despite adequate treatment of the underlying disease. Surgical correction is curative, but infrequently performed and historically associated with poor outcomes. This may be due to delayed diagnosis, lack of well-defined surgical indications, and, consequently, late intervention in patients in poor clinical condition with failing right ventricles. Because of limited evidence about timing and corresponding outcome of tricuspid valve surgery, current guideline recommendations are rather conservative and show several inconsistencies. Nevertheless, there has been a trend toward a more aggressive approach in the surgical treatment of TR with improved outcomes. Moreover, emerging transcatheter options claim to provide a lower-risk alternative for selected patients. This may facilitate earlier treatment and improve the attitude toward an early treatment strategy of secondary TR, yet is not reflected in the guidelines. Future research is needed for risk stratification to determine inclusion criteria and optimal timing for intervention.

继发性三尖瓣反流 (TR) 长期以来一直被认为是一种良性且耐受性良好的瓣膜病变，在治疗基础疾病后会消退。这一观点受到了数据的挑战，数据表明，尽管对基础疾病进行了充分治疗，但长期存在的 TR 可能是一种进行性疾病，导致右心室衰竭和终末器官损伤。手术矫正是有疗效的，但很少进行，而且历史上与不良结果相关。这可能是由于延迟诊断、缺乏明确的手术指征以及因此对临床状况不佳且右心室衰竭的患者进行了较晚的干预所致。由于有关三尖瓣手术时机和相应结果的证据有限，目前的指南建议相当保守，并且存在一些不一致之处。尽管如此，TR 的手术治疗已经出现了采用更积极的方法并改善预后的趋势。此外，新兴的经导管选择声称可以为选定的患者提供风险较低的替代方案。这可能有助于早期治疗并改善对继发性 TR 早期治疗策略的态度，但指南中并未反映出来。未来需要进行风险分层研究，以确定纳入标准和最佳干预时机。