Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures?

Abstract

Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a "forgotten" valve. Recently, the development of transcatheter interventions for TR show promising potential for use in the clinical setting. There are currently few approved and numerous tested percutaneously delivered devices, which can be categorized, based on their mechanism of action, to either valve repair or valve replacement procedures. Both procedures were tested in clinical trials and show an echocardiographic reduction in TR sustained for at least 1 year after the procedure, as well as symptom relief and functional improvement of the patients. Device selection should be personalized, taking into consideration the anatomy of each valve and the available options at each heart center. Moreover, appropriate patient selection and timing of the procedure are also crucial for the success of the procedure. In this review, we analyze the clinical trials available for all devices currently approved or tested, aiming to provide a comprehensive summary of the most recent evidence in the field of transcatheter TR interventions.

Keywords: interventional cardiology; transcatheter edge-to-edge repair; tricuspid regurgitation; tricuspid valve replacement.

Figure 1

There are currently four techniques for the transcatheter management of tricuspid regurgitation, which subsequently have numerous currently tested or approved devices that the interventionalist can choose. Each technique, based on anatomical considerations, has some favorable indications of use, mostly depending on the technique-specific repair mechanisms.

Figure 2

In the current era of tricuspid valve intervention, several parameters are of major significance for procedural success. The timing of the procedure should be carefully decided in regards to the course and severity of tricuspid regurgitation. The device selection has to be in accordance with each patient’s anatomy, as there is no “one size fits all” device. Finally, the patients who will benefit from transcatheter procedures should be carefully selected from a Heart Team, taking into consideration the surgical risk and the optimal intervention for each individual.