Right heart transcatheter valve therapies – a review of prostheses for the pulmonary and tricuspid positions

Abstract

Minimally invasive, catheter-based treatment of valvular dysfunction has become an integral part of clinical routine. As left heart valvular disease is much more common and thus commercially of interest, transcatheter solutions for the treatment of aortic and mitral valvular defects were the first to become broadly clinically available, while even today options for the right heart valve are rare. This review looks at innovative attempts at developing effective transcatheter heart valve prostheses for the pulmonary and tricuspid heart valves, details their experience and highlights those that have made their way to application in humans.

Keywords:

• catheter-based therapy
• GUCH
• pulmonary heart valve
• stent frame design
• transcatheter heart valves
• tricuspid heart valve
• valvular dysfunction
• valve-in-valve

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Transcatheter pulmonary valve implantation in a human preceded aortic valve implantation by 2 years, but the number of aortic valve implantation greatly exceeds that of pulmonary implantations.

• The challenging anatomies of the tricuspid valve apparatus and diseased right ventricular outflow tracts, especially in patients with congenital heart defects, make the design of prostheses for broad application challenging.

• The vast majority of transcatheter heart valve implantations in the pulmonary and tricuspid valves are performed to restore the function of dysfunctional bioprostheses or grafts.

• Adaptation of innovative therapies for the aortic and mitral valves will expedite the development of transcatheter therapies for the right side of the heart.

• Reconsidering the proper timing for transcatheter interventions for the tricuspid and pulmonary valves will broaden the application of the technology and ultimately benefit patients.

• Patients requiring right side transcatheter heart valves are commonly younger than left side transcatheter patients, leading to different device requirements.

• Most concepts for right side transcatheter heart valves show promising results in animal trials, but do not find their way into clinical practice.

• Development of right side transcatheter heart valves is commonly university driven, while left side transcatheter valve development is industry driven, due to the perceived larger commercial opportunities.