Percutaneous techniques for treatment of tricuspid valve dysfunction in congenital heart disease – an emerging therapy

ABSTRACT

Introduction: Tricuspid valve (TV) dysfunction treatment experiences exponential growth of the interest over the last years. New techniques for percutaneous tricuspid valve treatment are either on the market or in the early stages of development.

Areas covered: Deficiency of uniform guideline-based recommendations leads to diverse TV dysfunction treatment options. The current review describes the development of surgical techniques for TV dysfunction in Ebstein’s anomaly and transition to a variety of new technologies. Then, the focus is on the potential of percutaneous interventions to reduce the total number of open-heart surgeries in patients with congenital heart disease (CHD) after TV replacement with a bioprosthesis to improve TV function.

Expert opinion: TV dysfunction is usually a complex combination of anatomical cardiac features in CHD. Compared to adults with secondary TV dysfunction, CHD patients usually are younger and have experienced several open-heart surgeries at a young age. Therefore, TV dysfunction can affect long-term life expectancy and quality of life significantly. So far, surgery was the gold standard for TV dysfunction treatment. The duration of TV plasty or bioprosthesis is limited, while the risk of re-do operations increases with every procedure. Percutaneous TV implantation may reduce the total number of open-heart surgeries over a patient’s life.

KEYWORDS:

• Congenital heart disease
• Ebstein’s anomaly
• emerging therapy
• percutaneous tricuspid valve implantation
• transcatheter tricuspid valve implantation
• tricuspid valve
• tricuspid valve repair
• tricuspid valve replacement
• tricuspid valve-in-valve implantation

Article highlights

• Ideal surgical technique for TV dysfunction is very controversial.

• Failed valve repair is less frequent after cone repair compared to other repair techniques.

• Patients who return for repeated TV dysfunction often present in a poor clinical condition.

• PTVI into a failing bioprosthesis is a straightforward procedure with a relatively low periprocedural complication rate and reproducible results.

• Potential complications for PTVI include device malfunctioning, malposition, migration, and embolization.

Declaration of interest

S Cesna has declared that is a proctor for Medtronic, Boston Scientific and Meril Life Sciences Pvt.Ltd. A Eicken has declared that he is also a proctor for Medtronic. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.