Caval Valve Implantation: Are 2 Valves Better Than 1?

Abstract

The management of patients with severe symptomatic tricuspid regurgitation (TR) remains extremely challenging for cardiologists and cardiovascular surgeons alike. Medical therapy, consisting primarily of escalating doses of diuretics, becomes ineffective in the long term as patients develop increasing diuretic resistance because of worsening renal function. Although in the United States the use of surgery for TR has shown a slight increase during the past decade, only a small portion of eligible patients undergo surgery.1 This is for several reasons. As patients usually are only referred for surgery late in the disease process when they have severe end-organ compromise, the procedure can be more high risk. In addition, there can be a significant rate of late recurrence of TR post-surgery.2 It is in this setting that the field of transcatheter tricuspid valve intervention has blossomed during the past 5 years, with multiple devices in early stages of development. In this issue of Circulation: Cardiovascular Interventions , Lauten et al3 describe their experience with one of these techniques: caval valve implantation (CAVI).3 See Article by Lauten et al The concept of CAVI centers around the heterotopic placement of a valve in the inferior vena cava (IVC) alone or in combination with a second valve in the superior vena cava (SVC) to redirect the regurgitant jet from the failing tricuspid valve. Protection of the hepatic and renal veins from the effects of this chronic volume overload may help …