Transcatheter tricuspid valve repair is a minimally invasive, catheter-based procedure designed to treat tricuspid regurgitation (TR) in patients who are at high surgical risk or unsuitable for open-heart surgery.
The procedure is performed via a transvenous approach, typically through the femoral vein, under general anesthesia with echocardiographic and fluoroscopic guidance.
Tricuspid percutaneous transcatheter edge to edge repair (TEER) is safe in patients with severe tricuspid regurgitation, and reduces the severity of tricuspid regurgitation and is associated with improvement in quality of life.
Patients with severe tricuspid regurgitation generally are older adults with heart failure, atrial fibrillation, previous cardiac procedures in multiple coexisting medical conditions.
Disease modifying medical therapies are lacking for severe tricuspid valve regurgitation with a death risk factor for tricuspid valve surgery of approximately 6 to 7%.
For patient with severe tricuspid regurgitation, transcatheter tricuspid valve replacement is superior to medical therapy alone for the primary composite outcome, driven primarily by improvement in symptoms and quality of life (TRISCEND).
TEER involves a transvenous approach, and approximates the tricuspid valve leaflets by deploying a clip to hold the leaflet together and reduce tricuspid regurgitation without the need for cardiopulmonary bypass or cardiac surgery.
TEER reduces, tricuspid, regurgitation, alleviate symptoms, reduces, neurohormonal activation, and induces reverse modeling of the right heart, compared with medical therapy alone:but this trial did not show difference in the incident of death or hospitalization for heart failure at one year, suggesting that coexisting conditions are primary determinants of outcome.
TEER is the most common transcatheter therapy worldwide.
TEER compared to medically treated patients is associated with the lower incidence of the composite end point of death and rehospitalization.
Metaanalysis showed mortality rate of 5% for the TEER procedure at 30 days, and an overall mortality of 25% at one year.
More than 10% of patients experience, major bleeding, and more than 15% require cardiac implantable electronic devices.
TEER devices can reduce tricuspid regurgitation to moderate or less than 80 to 85% of patients and two mild or less and only 30 to 50% of patients.
Transcatheter edge to edge repair reduces, tricuspid regurgitation severity, and improves patient reported outcome measures in patients with severe symptomatic tricuspid regurgitation (Tri-Fr investigators).
It reduces the severity of TR and improve symptoms and quality of life.
There are two main categories of devices used for transcatheter tricuspid valve repair: coaptation devices and annuloplasty devices.
Coaptation devices: TriClip and PASCAL systems, function by approximating the tricuspid valve leaflets to reduce regurgitation, similar to the edge-to-edge repair technique used in the mitral position.
Annuloplasty devices, such as the Cardioband system, mimic surgical annuloplasty by reducing the size of the tricuspid annulus to decrease the regurgitant orifice area.
The choice of device depends on the patient’s anatomy and the mechanism of TR.
Coaptation devices function similarly to the devices used on the mitral valve and approximate the leaflets of the tricuspid valve at the location of the regurgitant jet to reduce the severity of regurgitation.
In contrast, annuloplasty devices mimic a surgical annuloplasty ring to reduce the regurgitant orifice area of the tricuspid regurgitation.
Transcatheter tricuspid valve repair can achieve significant reductions in TR severity, improvements in functional status and enhanced quality of life, with a favorable safety profile in high-risk populations.
The transcatheter edge-to-edge repair (TEER) is currently the most common transcatheter tricuspid valve repair procedure being performed in clinical practice.
TEER can improve symptoms. It rarely eliminates TR and worsening or persistent TR after the procedure is associated with worse outcomes.
Transcatheter tricuspid valve replacement (TTVR, has emerged as an option to treat tricuspid regurgitation: trials demonstrate acceptable, safety, near complete TR elimination and significant health status improvement in an older comorbid population.