Transcatheter Tricuspid Valve Replacement

Abstract

New transcatheter technologies for the treatment of severe tricuspid insufficiency, in patients at high surgical risk, are demonstrating promising efficacy and a high safety profile. In certain conditions of advanced right failure, with significant tethering of the leaflets, repair techniques are not the ideal solution, reporting a fair rate of residual insufficiency. In this context, transcatheter tricuspid replacement could be a very attractive and effective solution. An accurate multimodality imaging analysis of the right function represents a sine qua noncondition, in order to prevent fatal postoperative ventricular dysfunction (valve replacement leads to an immediate abolition of tricuspid insufficiency and subsequent afterload mismatch). This manuscript will illustrate the procedure of transcatheter tricuspid replacement with the GATE System (NaviGate Cardiac Structures, Inc., Lake Forest, CA), step by step. Other transcatheter replacement technologies, analogous to the GATE, are currently being developed and will produce further results in the near future. The evolution of imaging techniques will contribute to the further development of these therapies. New transcatheter technologies for the treatment of severe tricuspid insufficiency, in patients at high surgical risk, are demonstrating promising efficacy and a high safety profile. In certain conditions of advanced right failure, with significant tethering of the leaflets, repair techniques are not the ideal solution, reporting a fair rate of residual insufficiency. In this context, transcatheter tricuspid replacement could be a very attractive and effective solution. An accurate multimodality imaging analysis of the right function represents a sine qua noncondition, in order to prevent fatal postoperative ventricular dysfunction (valve replacement leads to an immediate abolition of tricuspid insufficiency and subsequent afterload mismatch). This manuscript will illustrate the procedure of transcatheter tricuspid replacement with the GATE System (NaviGate Cardiac Structures, Inc., Lake Forest, CA), step by step. Other transcatheter replacement technologies, analogous to the GATE, are currently being developed and will produce further results in the near future. The evolution of imaging techniques will contribute to the further development of these therapies. Commentary: Transcatheter Tricuspid Valve Replacement: Promising Alternative to Repair but More Unknowns than KnownsOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 26Issue 3PreviewThe tricuspid valve (TV) is now no longer a forgotten valve, with significant advances in the understanding of anatomy and morphology, imaging and less invasive alternatives to surgery to treat severe tricuspid regurgitation (TR). Given secondary TR accounts for a majority of cases, tricuspid repair is the mainstay therapy in surgery, most commonly in the form of a ring annuloplasty.1 The procedure is straightforward, can be done on a beating heart, and typically takes only 10-15 additional minutes of operating time. Full-Text PDF