Transcatheter tricuspid valve intervention techniques and procedural steps for the treatment of tricuspid regurgitation: a review of the literature

Abstract

Severe tricuspid regurgitation (TR) is an undertreated common pathology associated with significant morbidity and mortality. Classically, surgical repair or valve replacement were the only therapeutic options and are associated with up to 10% postprocedural mortality. Transcatheter tricuspid valve interventions are a novel and effective therapeutic option for the treatment of significant TR. Several devices have been developed with different mechanisms of action. They are classified as annuloplasty devices, replacement devices, caval valve implantation and coaptation devices. In this review, we provide a step-by-step description of the procedural steps and techniques of every device along with video support.

Keywords: Annuloplasty; CAVI; Coaptation device; Percutaneous Interventions; Procedural Steps; Transcatheter Tricuspid Valve Interventions; Tricuspid Regurgitation.

Figure 1

Tricuspid valve intervention devices with reported clinical use from Advances in transcatheter mitral and tricuspid therapies’ by Overtchouk et al.,2020, BMC Cardiovascular Disorders 20, 1. Reprinted with permission from Overtchouk et al.

Figure 2

Proposed algorithm to guide transcatheter tricuspid valve intervention device selection. CIED, cardiovascular implantable electronic device; ESLD, end-stage liverg disease; ESRD, end-stage renal disease; PH, pulmonary hypertension; SLD, severe lung disease; TEER, transcatheter edge to edge repair; TR, tricuspid regurgitation; TTVR, transcatheter tricuspid valve replacement. *: refer to table 2 for ideal and complicating factors of technique.