Percutaneous tricuspid valve therapies: the new frontier

Abstract

Moderate-to-severe tricuspid regurgitation (TR) affects ∼1.6 million patients in the USA, of whom only 8000 undergo tricuspid surgery annually; this results in an extremely large number of untreated patients with significant TR. Therefore, there is a large unmet clinical need for patients with severe TR who are not referred for conventional surgery, mainly due to expected high surgical risk. Percutaneous procedures are an attractive alternative to surgery for patients deemed to be high-risk surgical candidates. Whereas over the past few years, the development and clinical use of percutaneous approaches to the aortic valve and mitral valve have been widespread, few data are available about the feasibility and the efficacy of the percutaneous tricuspid valve treatment. This review will explore the available technologies, which are today under evaluation and the preliminary clinical results.

Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes

“…In the future, those percutaneous procedures might become an attractive alternative to surgery for high risk patients [38][39][40]. However, it is important to underline that pre-clinical and clinical experiences with transcatheter TV therapies are currently very preliminary and only very few data are currently available.…”

Assessment of tricuspid valve by two‐ and three‐dimensional echocardiography with special reference to percutaneous repair and prosthetic valve implantation procedures

“…35 Usually, the AL and PL are visualized in most planes, but the PL(IL) may be detected opposite the AL in the RV inflow view. 1 Influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure, etc.) 37 In our experience, the most reliable approach to assess RV and hence pulmonary artery (PA) systolic pressure (in the absence of RV This standardization of the Nyquist limit and color Doppler gain is very important in estimating TR severity but has not been emphasized enough in the current guidelines.…”

“…[1][2][3] Acceptable results have been reported postoperatively. Subsequently, there has been evidence favoring a more assertive surgical approach to this valvopathy; recent guidelines recommend surgical attention be paid to the TV when FTR or nonsevere TR with a dilated tricuspid valve annulus (TVA) accompanies left-sided disease; and at the time, the latter is being operatively addressed.…”

Transcatheter Valve-in-Valve Implantation for Failing Bioprosthetic Triscupid Valves

“…Tricuspid VIV procedures are only the tip of the iceberg of a whole new approach to transcatheter repair of tricuspid valve pathologies that are currently under investigation. 20 In this context, it is important to recognize that well-characterized, prospective, and adjudicated international registries remain an important tool for infrequent and novel procedures. Such registries should probably be applied more broadly to the majority of new technologies in the field of structural interventions.…”