Advances in transcatheter mitral and tricuspid therapies

Abstract

Background: While rheumatic mitral stenosis has been effectively treated percutaneously for more than 20 years, mitral and tricuspid regurgitation treatment appear as a contemporary unmet need. The advent of transcatheter therapies offer new treatment options to often elderly and frail patients at high risk for open surgery. We aimed at providing an updated review of fast-growing domain of transcatheter mitral and tricuspid technology. Main body: We reviewed the existing literature on mitral and tricuspid transcatheter therapies. Mitraclip is becoming an established therapy for secondary mitral regurgitation in selected patients with disproportionately severe regurgitation associated with moderate left ventricle dysfunction. Evidence is less convincing for primary mitral regurgitation. Transcatheter mitral valve replacement is a promising emerging alternative to transcatheter repair, for secondary as well as primary mitral regurgitation. But further development is needed to improve delivery. Transcatheter tricuspid intervention arrives late after similar technologies have been developed for aortic and mitral valves and is currently at its infancy. This is likely due in part to previously under-recognized impact of tricuspid regurgitation on patient outcomes. Edge-to-edge repair is the most advanced transcatheter solution in development. Data on tricuspid annuloplasty and replacement is limited, and more research is warranted. Conclusion: The future appears bright for transcatheter mitral therapies, albeit their place in clinical practice is yet to be clearly defined. Tricuspid transcatheter therapies might address the unmet need of tricuspid regurgitation treatment.

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

“…10 The RAA vestibule and its adjoining isthmuses are clinically important structures where right accessory pathways are predominantly distributed and thus may be used as targets for catheter ablation or as sites for device implantation during percutaneous right atrioventricular valve repairs. [13][14][15][16] Invasive transcatheter procedures are challenging and are associated with numerous complications. The most serious setbacks associated with these procedures include atrial wall rupture, cardiac tamponade, and local blood vessel injury.…”

Right-sided double valve replacement in an adult patient who underwent surgery for pulmonary stenosis in childhood: a case report

“…Recently, transcatheter interventions for valvular heart diseases, especially aortic valve, have made remarkable progress. Transcatheter tricuspid intervention might be a promising alternative to open surgical procedures for high-risk patients with FTR, including previous cardiac surgery such as the present case, because of its low invasiveness [12]. However, it is still in its infancy, and further investigation of the clinical applicability of the interventions is needed.…”

Interventional treatment of tricuspid regurgitation

“…The best results appear to be obtained by approximating the anterior and/or posterior leaflet to the septal leaflet, which also potentially reduces annular dimensions. Clipping the anteroposterior leaflets is generally avoided in functional TR because it may distort the valve and worsen TR [9].…”