Abstract
Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices.
Highlights
Severe symptomatic tricuspid regurgitation (TR) is associated with poor short- to medium-term clinical outcomes, representing a leading cause of moderate-to-severe heart valve disease in developed countries [1,2]
Caval valve implantation (CAVI) emerged initially as an alternative therapy for patients deemed as having ‘no other options’ for treating their severe symptomatic TR; such patients often afflicted with concomitant hepatic congestion and right heart failure [5]
Given the emerging challenges and applicability of many emerging percutaneous tricuspid valve (TV) therapies to the broader cohort of severe TR candidates, the simplicity of CAVI underscores its attractiveness as an effective treatment option for many severe TR patients
Summary
Severe symptomatic tricuspid regurgitation (TR) is associated with poor short- to medium-term clinical outcomes, representing a leading cause of moderate-to-severe heart valve disease in developed countries [1,2]. Medical treatment and tricuspid valve (TV) surgery are the currently accepted therapies to treat severe symptomatic TR. Several percutaneous devices have emerged during last decade to treat severe TR, with promising results in early feasibility studies, with pivotal randomized trials ongoing [5]. Caval valve implantation (CAVI) emerged initially as an alternative therapy for patients deemed as having ‘no other options’ for treating their severe symptomatic TR; such patients often afflicted with concomitant hepatic congestion and right heart failure [5]. The objective of this review is to illustrate the current evidence and ongoing uncertainties of CAVI, advantages/disadvantages compared with other percutaneous TV devices, CAVI-related planning and technical aspects, and post-implant care of CAVI recipients
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