Transcatheter tricuspid valve interventions

Summary

Tricuspid regurgitation (TR) increases with age, reaching about 4% of patients 75 years old, and is associated with increased risk of cardiovascular events and death at long-term follow-up.

Functional TR is the most frequent form of TR, due to the remodeling and dysfunction of right heart chambers resulting in tricuspid annulus dilatation and dysfunction with or without associated leaflet tethering. Often, it is observed in patients with right ventricle remodeling and pulmonary hypertension, usually secondary to left-heart valvular disease (with or without previous surgical correction, “ventricular TR”). It also develops following tricuspid annulus dilatation/dysfunction in the setting of atrial fibrillation without left-heart disease (“atrial TR”).

Echocardiography is the cornerstone of TR assessment, including regurgitation severity, valve anatomy and right ventricle function. Alongside this, cardiac computed tomography and right heart catheterization are used increasingly to adequately selected patients and plan the procedures.

Depending on the specific tricuspid apparatus, numerous and very different transcatheter therapies are available to address different targets, including leaflet approximation, annuloplasty, valve replacement, valve-in-valve implantation and heterotopic valve implantation. Such devices are still in an early phase of development, but initial evidences are favorable and promise to allow more patients affected by TR to receive a...