This JACC State-of-the-Art Review article provides a comprehensive overview of transcatheter tricuspid valve replacement (TTVR) for treating severe tricuspid regurgitation. The article details current TTVR systems, their mechanisms, and clinical outcomes from various studies, including a randomized controlled trial. It also explores diagnostic work-up, patient selection criteria, procedural considerations (such as managing complications like bleeding and conduction disturbances), and post-procedure care, including anticoagulation strategies. The authors offer expert recommendations based on their experience, highlighting both the potential benefits and challenges associated with TTVR. Finally, the review discusses future research directions and ongoing clinical trials aimed at expanding the understanding and application of this evolving therapy.