Abstract
Tricuspid valve regurgitation is one of the most common valvular disorders and moderate to severe tricuspid regurgitation is consistently associated to an increased morbidity and mortality. From an etiopathological perspective, tricuspid regurgitation can be classified in primary, due to the organic disease of any of the valve components, or secondary, as a result of tricuspid valve annulus dilatation, adverse right ventricular remodeling and tricuspid valve leaflet tethering. Despite its poor prognosis, most patients with tricuspid insufficiency are managed conservatively and only those with concomitant left heart valvular disease do finally go surgery in the real-world setting. In fact, outcomes of conventional surgery in patients with isolated tricuspid regurgitation are poor and this approach has not proven yet any survival benefit over stand-alone medical therapy. Given this unmet need, new transcatheter techniques have been developed in the last years, including leaflet plication, percutaneous annuloplasty and valve implantation in either the tricuspid position (orthotopic implantation) or in a different position such as the vena cava (heterotopic implantation). These techniques, with promising outcomes, are seen as an interesting alternative to open-heart surgery given the much lower periprocedural risk.
Highlights
Moderate or severe tricuspid regurgitation (TR) is a common disorder affecting over 1.6 million people in the United States and close to 70 million worldwide [1, 2]
The tricuspid valve (TV) is a complex structure composed of three leaflets, a fibrous TV annulus (TVA) in which these leaflets are inserted, at least two papillary muscles with multiple tendinous cords and the adjacent atrial and right ventricular (RV) myocardium
The presence of invasive PH, defined as pulmonary artery systolic pressure > 50 mmHg), together with discordant absence of PH by echocardiographic estimation, was associated with the combined primary endpoint of all-cause mortality, need for repeat hospitalization for heart failure (HF) and reintervention during follow-up. This could be explained because in advanced stages of TR associated with adverse RV remodeling with severe dilation of the TV annulus, pulmonary hypertension may be severely underestimated by echocardiography
Summary
Moderate or severe tricuspid regurgitation (TR) is a common disorder affecting over 1.6 million people in the United States and close to 70 million worldwide [1, 2]. TR has been traditionally considered to be a benign valve disorder in comparison with left valve disease, it is associated to a poorer prognosis. This finding has been consistently reported in different clinical scenarios, even in the absence of PH or right-side heart failure (HF) [4, 5]. Surgical tricuspid valve (TV) repair or replacement in isolated TR is fairly indicated and reported periprocedural mortality can be as high as 20% [7, 8]. New percutaneous techniques have shown promising results for the treatment of TR and appear as an alternative to conventional surgery in those cases where only conservative management could be offered in the past due to high surgical risk. In this chapter we will review the different devices that are currently available and to date published evidence for these approaches
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