Recent advances in managing tricuspid regurgitation.

Benedetto Del Forno,Alessandro Castiglioni,Malcom Dalrymple-Hay,Michele De Bonis,Ottavio Alfieri,Elisabetta Lapenna,Maurizio Taramasso

doi:10.12688/f1000research.13328.1

Abstract

Isolated tricuspid valve surgery is usually carried out with very high morbidity and mortality given the complexity of the affected patients. In light of this, trans-catheter tricuspid valve interventions have been emerging as an attractive alternative to surgery over the last few years. Although feasibility has been shown with a number of devices, clinical experience remains preliminary and associated with significant clinical and technical challenges. Here we describe currently available trans-catheter treatment options for severe tricuspid regurgitation implanted in different locations.

Highlights

Tricuspid valve insufficiency is reported as the most common valvular heart disease, affecting 65 to 85% of the population[1]; the true prevalence of moderate or severe tricuspid regurgitation (TR) has been estimated at 1.6 million people in the United States[2]
Functional TR frequently coexists with left-sided valve disease (LVD), but avoidance of concomitant tricuspid valve repair was accepted based on the incorrect assumption that TR would improve once the primary LVD had been treated[4]
Trans-catheter therapies for tricuspid regurgitation Given the considerable surgical risk of tricuspid valve surgery for severe TR, especially in the reoperation scenario, there has been a progressive development of percutaneous trans-catheter techniques in the last few years

Summary

Introduction

Tricuspid valve insufficiency is reported as the most common valvular heart disease, affecting 65 to 85% of the population[1]; the true prevalence of moderate or severe tricuspid regurgitation (TR) has been estimated at 1.6 million people in the United States[2]. Trans-catheter therapies for tricuspid regurgitation Given the considerable surgical risk of tricuspid valve surgery for severe TR, especially in the reoperation scenario, there has been a progressive development of percutaneous trans-catheter techniques in the last few years Anatomical aspects, such as the non-planar and large tricuspid annulus, absence of calcium, right ventricular geometry, and approximation of critical surrounding structures, have to be taken into consideration and make this procedure very challenging[14]. Trans-catheter tricuspid valve annuloplasty Severe functional TR is due to a significant annular dilatation, and that is why surgical annuloplasty is the first procedure of choice in treating this condition. Applying this principle to the percutaneous techniques results in several complexities. An early feasibility trial is currently ongoing in the United States (NCT02471807)

Results

26. Rogers J

30. Perlman G