Interventional Cardiology Perspective of Functional Tricuspid Regurgitation

Abstract

A vast unmet need exists for tricuspid valve (TV) repair for functional tricuspid regurgitation (FTR) among patients undergoing left heart valve surgery. The FTR is a dynamic entity that is governed by several pathophysiologic mechanisms like TV annular dilatation, annular shape, pulmonary hypertension, left or right ventricle dysfunction, right ventricle geometry, and leaflet tethering. Treatment options for FTR are primarily surgical. No clear medical management exists for treatment of FTR. Several studies have demonstrated improvement in functional status along with tricuspid regurgitation grades among individuals undergoing concomitant TV repair as compared with those undergoing only left heart valve surgery, although data on mortality benefits are equivocal. Percutaneous TV technology may be initially useful for patients with FTR who are at high risk for open-heart surgery. Once the other percutaneous technologies for mitral, aortic, or pulmonary valve become widely available, the need for percutaneous TV procedures will be even more apparent. Initial data from animal studies have shown encouraging results. A concurrent effort is being invested to develop effective mechanistic models, right stent materials, superior valve devices along with a precise technology for valve deployment. The current prevalence of moderate-to-severe tricuspid regurgitation (TR) is estimated to be 1.6 million in the United States.1 Of these, only ≈8000 patients undergo tricuspid valve (TV) surgeries annually, most of them in conjunction with left heart valve surgeries (LHVSs).1 This has resulted in a vast unmet need of recognizing and effectively treating TR in adult populations. With the decline of rheumatic heart disease, a large proportion of the TR encountered is functional rather than organic. Functional TR (FTR) refers to the TR secondary to the left heart pathology or right heart pathology in the face of a normal TV leaflet morphology. The methods of detecting TR have evolved considerably over the years. The …