Tricuspid Regurgitation – Medical Management and Evolving Interventional Concepts

Abstract

Severe tricuspid regurgitation (TR) is a complex condition of the right ventricle (RV) and tricuspid valve apparatus and is frequently associated with symptomatic heart failure and a significant morbidity and mortality. In these patients, left heart pathologies lead to chronic pressure overload of the RV, eventually causing progressive RV dilatation and functional TR. Therefore, TR cannot be considered as isolated heart valve disease pathology but has to be understood and treated as one component of a complex structural RV pathology and is frequently also a marker of an advanced stage of cardiac disease. In these patients, medical therapy restricted to diuretics and heart failure medication is frequently ineffective. Also, severe TR in the setting of advanced heart failure constitutes a high risk for cardiac surgery. Neither one of these treatment options has demonstrated a beneficial effect on long-term prognosis. The recent innovations in transcatheter technology led to efforts to develop interventional approaches to severe TR. Multiple innovative treatment concepts are currently under preclinical and clinical investigation to replace or repair TV function. However, up to date none of these approaches is established and there is still a lack of clinical data to support the efficacy of transcatheter TR treatment.

Tricuspid valvuloplasty for isolated tricuspid regurgitation in children

“…It was generally acknowledged that isolated tricuspid regurgitation can be well tolerated, and even one patient without clinical symptoms for 32 years. 7,15 But not all children responded well to drug therapy and some patients died from chronic cardiac failure or pneumonia in previous reports. 6 Thus, some patients require timely surgical intervention, repair, or replacement.…”

Healthcare utilization in clinically significant tricuspid regurgitation patients with and without heart failure

“…Several conditions that cause right-ventricle dilation are associated with TR. These include heart failure (HF) diastolic, systolic, combined or unspecified, right-sided heart disease (RSHD) defined as patients with right ventricular dysfunction (RVD), chronic obstructive pulmonary disease (COPD), idiopathic pulmonary arterial hypertension (IPAH) or atrial fibrillation (AF), patients with other valve disease (aortic or mitral) [4][5][6][7].…”

“…Severe TR is independently associated with high morbidity and mortality but patients are frequently asymptomatic and therefore the focus of treating this condition is primary based on symptoms [2,3,[7][8][9][10][11][12][13]. Consequently, TR is often overlooked until it progresses in severity.…”

“…Consequently, TR is often overlooked until it progresses in severity. Current guidelines recommend that surgery to treat severe TR be performed concomitantly with left-sided heart valve surgeries [4,5,7,[13][14][15]. As a result, TR surgery is infrequently performed as a standalone procedure compared with other forms of cardiac surgery [16].…”

“…Currently, Topilsky et al estimate TR prevalence at: approximately 0.55% in the USA, which is adjusted for age and sex [17]. However, the complex pathology of TR and its associated conditions could result in its underrecognition and make it difficult to assess the true prevalence [6,7,9,13,15]. Additionally, confounders likely delay treatment for TR, despite poor prognosis, which increases healthcare utilization [5,18,19].…”