Developments in transcatheter tricuspid valve therapies

ABSTRACT

Introduction: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.

Areas covered: A literature search was performed using PubMed. Authors review clinical evidence in this field, the imaging features and the developments in TV transcatheter technologies. Currently, transcatheter devices for TV procedures can be allocated into four main groups: 1) those ones targeting leaflet malcoaptation, 2) those addressing annular dilatation, 3) those performing heterotopic valve implantation and 4) those onesaccomplishing a complete transcatheter replacement of the valve.

Expert opinion: Actually, encouraging results are provided by initial experience in the field of transcatheter TV procedures. However, this field remains full of challenges that faced could lead to better results and prognosis for the patients. The next steps in this emerging field will need to focus on accurate patient selection, an early patient referral and on studies comparable and providing long-term data.

KEYWORDS:

• Transcatheter tricuspid valve treatment
• tricuspid regurgitation
• tricuspid valve
• valvular heart disease
• transcatheter tricuspid valve therapy

Article highlights

• The incidence of untreated patients with severe tricuspid regurgitation is increasing each year and only a minority of them undergo surgical repair, because it is associated with an elevated in-hospital mortality.

• Transcatheter tricuspid valve procedures are a valid alternative for these high-risk patients with symptomatic TR and the interest in this field has largely grown in the last years with the development of many tricuspid transcatheter devices.

• Sharing the most updated imaging methodologies will help to better understand the anatomy of the valve and to select the suitable patients for these procedures, with a better timing and a consequently better clinical benefit after the procedures.

• In order to better understand and to get a more complete view of these procedures and these devices, it is important to analyze data coming from future clinical trials.

• New fundamental evidences in this field will be provided by matching patients undergoing transcatheter tricuspid therapies vs guidelines directed medical therapy alone.

Declaration of interest

Dr. Miura is a consultant for Japan Lifeline.

Dr. Gavazzoni is consultant for Biotronik.

Dr. Taramasso is a consultant for Abbott Vascular and 4 Tech, Boston CoreMedical, speaker for Edwards.

Dr. Maisano is a consultant for Abbott Vascular, Medtronic, Edwards Lifesciences, Perifect, Xeltis, Transseptal solutions, Cardiovalve, Magenta; receives Grant Support from Abbott Vascular, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, and receives royalties from Edwards Lifesciences, 4 Tech, Transseptal solutions, Perifect, and Cardiovalve.

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

A reviewer on this manuscript has disclosed that they are affiliated with Speaker’s bureau, Abbott labs and are an Edwards Lifesciences consultant. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.