An overview of surgical treatment modalities and emerging transcatheter interventions in the management of tricuspid valve regurgitation

Abstract

Tricuspid valve regurgitation (TR) is frequently encountered and is most often functional (FTR) in nature. Surgical tricuspid valve (TV) treatment is well established in specialized centers. While transcatheter therapy for other valve disease is well established, interventional treatment of TV disease is still in its early stages. With the increasing adoption of catheter-based treatments, there is a growing interest in and need for interventional treatments for TR. An extensive literature search was methodologically performed aiming for an integrative review paper. Areas covered: This review will discuss the current surgical treatment modalities and emerging transcatheter interventions in the management of TR. Furthermore, this review will describe the pathophysiology of functional tricuspid regurgitation (FTR), and the new 2017 ESC/EACTS guidelines for the management of TR. Finally, a five-year view into the future will be stated. Expert commentary: At their center, the authors have an aggressive approach for the treatment of FTR owing to its significant impact on perioperative as well as late postoperative morbidity and mortality. The authors perform TV ring annuloplasty when substantial annular dilation (≥45mm) is observed. In the future, percutaneous TV technologies might become an alternative option to treat TR patients with high surgical risk selectively.

Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling

“…Digital processing yields multiplanar three-dimensional reconstructions of the area of interest with desirable spatial and temporal resolution. Thin image slices allow for detection of distinct valvular boundaries and useful spatial information for assessing RV function [67]. Studies support the prognostic value of cardiac CT for indexing FTR—such parameters include the RA and RV volumes, the leaflet tethering angles and height, and the annular diameter and area [68,69,70].…”

“…Studies support the prognostic value of cardiac CT for indexing FTR—such parameters include the RA and RV volumes, the leaflet tethering angles and height, and the annular diameter and area [68,69,70]. CT has also been used in the post-operative assessment of annuloplasty ring dislodgment and quantification of the spatial relationship between pacemaker leading in the RV and the associated TR [67,68,71]. Despite its attractive capabilities and applications to the heart valve leaflets, CT exposure must be monitored and limited due to the potential adverse effects of the radiation during the X-ray measurements.…”

Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures

“…It is typically diagnosed incidentally or when the pathology has led to severe clinical symptoms [1]. Disorders of the RAV are mainly treated with surgical techniques [2]. However, these procedures are challenging and have a high risk of complications [2][3][4].…”

“…Disorders of the RAV are mainly treated with surgical techniques [2]. However, these procedures are challenging and have a high risk of complications [2][3][4]. Therefore, clinicians are exploring less invasive treatment alternatives [5,6].…”

Percutaneous Valve-in-Valve Treatment of a (Very Old and Fluoroscopy Invisible) Degenerated Tricuspid Prosthesis Through the Right Jugular Vein Approach

“…Yet, due to high surgical risk, it often remains undertreated (1). Recently, the rapid development of trans-catheter approaches, allowed to considering tricuspid valve patients with high surgical risk as potential candidates for percutaneous approaches (2). Among the different opportunity offered by transcatheter techniques, the valve in valve represents an emerging strategy to treat patients with degenerated surgical biological prosthesis in the left system.…”