New Therapeutic Advances in the Management of Tricuspid Valve Regurgitation

Abstract

Tricuspid regurgitation (TR) is an intricate disorder that has a negative outlook, while surgical treatment is linked to increased mortality. Primary TR occurs due to a structural defect in the tricuspid valve (TV), while secondary TR is a more prevalent condition often associated with pulmonary hypertension, heart failure, and atrial fibrillation. The use of specific surgical procedures to improve TR is limited in everyday clinical practice due to the heightened surgical risk and delayed patient presentation. The development of other transcatheter heart valve procedures has led to a significant increase in transcatheter TV operations, which can be attributed to certain technological advancements. This review aims to provide an updated overview of transcatheter TV procedures, available alternative therapies, and standards for patient selection. It will also highlight the current state of development in this field, which is characterized by rapid progress and numerous ongoing clinical trials.

Keywords: transcatheter heart valve procedures; transcatheter tricuspid valve procedures; transcatheter tricuspid valve replacement; tricuspid regurgitation; tricuspid transcatheter edge-to-edge repair; tricuspid valve.

Figure 1

A 81 year old man presented with symptoms of RV heart failure and torrential tricuspid regurgitation. He was under optimal medical therapy. Echocardiography subsequently demonstrated torrential tricuspid regurgitation with posterior leaflet flail. After Heart Team review, the patient underwent transcatheter tricuspid valve repair with the TriClip™ system (Abbott Vascular, Santa Clara, CA, USA). (A,B): Transcatheter tricuspid valve repair with the TriClip™ system. (C,D): Intra-procedural transoesophageal echo revealing the torrential tricuspid regurgitation and assisting the operators for the optimal implantation of the clips.