The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming

Abstract

The tricuspid valve (TV) has been known as the forgotten valve. However, considering recent information from scientific studies, this nomenclature may need to be adjusted for the valve, which also needs to be better studied and understood. For decades, tricuspid regurgitation (TR) was not fully appreciated and was never the priority. However, studies have revealed that such pathology is related to a possible negative impact on prognosis of patients. Severe TR is a predictor of higher mortality. For the treatment of TR, repair or valve replacement can be performed. Repair techniques can be performed on the annulus (suture annuloplasty or ring implant), on the leaflets (e.g. triangular resection), on the cords (transfers or new cords) and on the papillary muscles (e.g. sliding technique). The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy. Nowadays transcatheter therapies have been used and studied. The main transcatheter strategies for the treatment of TR are based on reduction of the annulus (Cardioband, Trialign, TriCinch, Millipede and TRAIPTA), improvement of the leaflet coaptation (Mitraclip, FORMA device, PASCAL system, and TV occluder), reduction of the reflux for the vena cava system (Tric valve and Sapien valve implant), and valve implants (Navigate, Trisol, Sapien, Melody). In this context, there are still other devices (such as Tricentro, Pasta, etc.) being developed and tested throughout several phases of research. In the future, improved knowledge of the TV and the evolution of transcatheter treatments will alter the history of the TV. The transcatheter revolution is coming!

Visualisation of the tricuspid valve using a new 3D echocardiographic scoring system

“…TV interventions can be divided into two groups: ‘anulus-based’ and ‘leaflet-based’ systems. Anulus-based systems such as Edwards cardioband tricuspid systems (Edwards Lifesciences, Irvine, California, USA) 12 require sufficient visualisation of the TV ring. Via transvenous catheter technique, a band is attached to the ring from the RA side of the valve, aiming to reduce the ring circumference and ensure a better coaptation of the leaflets.…”

“…The MitraClip XT System (Abbott, Abbott Park, Illinois, USA) is the most common ‘leaflet-based’ system. 12 13 Via transvenous access, a clip that connects two leaflets is applied from the right atrial side of TV (edge to edge repair). Therefore, imaging of the leaflet edges is crucial.…”

Tricuspid valve diseases: Interventions on the forgotten heart valve

“…In cases where annuloplasty might be insufficient, such as in tethering, 42,44 there are alternatives such as enlargement of the anterior leaflet or the "clover" technique.…”

“…44 Various reviews in this topic have not discussed the possibility of transcatheter cordal interventions. 3,42,54…”

“…Transposition (or more simple moving) of the existing cords or the introduction of artificial cords can be considered if there is a cordal rupture 44 . Various reviews in this topic have not discussed the possibility of transcatheter cordal interventions 3,42,54 …”