The management of mitral valve (MV) and tricuspid valve (TV) regurgitation has undergone significant transformation during the past decade. This change has been driven by a growing understanding of the adverse clinical consequences of these conditions, particularly their strong association with heart failure progression, reduced quality of life, and increased mortality-and by the emergence of effective transcatheter options for valve intervention. Among these, transcatheter MV edge-to-edge repair and replacement and transcatheter tricuspid edge-to-edge repair and replacement have become important therapeutic tools that provide a less invasive alternative to surgery in appropriately selected patients. In this clinical practice update we aim to provide contemporary, evidence-based guidance for clinicians in the evaluation and management of patients with severe, symptomatic MV or TV regurgitation who might benefit from transcatheter intervention. Key topics include the clinical presentation of these valve lesions, the diagnostic evaluation with emphasis on multimodality imaging and hemodynamics, criteria for patient selection, and current data on procedural and long-term clinical outcomes. A central theme is the role of timely referral and structured assessment to avoid missed opportunities for intervention. Optimal outcomes require active engagement from referring physicians and close collaboration within a multidisciplinary heart team, including cardiologists, cardiac surgeons, imaging specialists, heart failure specialists, and nursing partners-to ensure careful patient selection, procedural planning, and comprehensive post-intervention follow-up. By integrating clinical judgement with guideline-based recommendations and procedural expertise, transcatheter edge-to-edge repair or transcatheter valve replacement can offer substantial symptomatic relief and improved quality of life for selected patients, while minimizing procedural risk and enhancing overall cardiovascular outcomes.

The VESALIUS-CV (VESLAIUS-CardioVascular) trial appeared too late to inform recent multisociety dyslipidemia guidelines, and its findings have already prompted consideration of whether the boundary between primary and secondary prevention no longer holds when a low-density lipoprotein cholesterol goal is being set. If that concession is granted, the more difficult question is an operational one that remains unanswered: at the bedside, which patient is a VESALIUS-CV patient? Herein we set the primary-secondary distinction aside altogether and offer a practical worksheet for identifying the subjects who merit more aggressive lipid-lowering, and access to proprotein convertase subtilisin/kexin type 9 inhibitors when necessary to reach new and lower low-density lipoprotein cholesterol goals.