JACC Associate Editor Celina M. Yong, MD, FACC, and JACC: Case Reports Editor in Chief Gilbert H. L. Tang, MD, MSc, MBA, FACC, discuss this paper published in JACC and presented at TCT. TRILUMINATE Pivotal is the first randomized, controlled trial evaluating transcatheter edge-to-edge repair (T-TEER) for severe tricuspid regurgitation (TR). Adaptive design randomized 572 subjects in the primary or subsequent cohorts. Subjects were elderly with atrial fibrillation and prior HFH. Primary endpoint was met at 1 year with a larger win ratio for T-TEER driven by KCCQ improvement with no significant differences in mortality and tricuspid valve surgery or HFH.