Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation

ABSTRACT

Background and Objective

Tricuspid regurgitation is a prevalent and undertreated cardiac pathology impacting millions across the globe. While historically surgical interventions for isolated tricuspid regurgitation were largely avoided due to data citing poor surgical outcomes, advances in transcatheter techniques and imaging modalities have reframed the approach to tricuspid valve disease in promising new ways.

Methods

Here we sought to provide a landscape review of the current state of the field for transcatheter tricuspid valve interventions. We first start with a descriptive overview of the tricuspid valve, reviewing the anatomy, imaging characteristics, and the current guidelines for tricuspid interventions. We then review both transcatheter valve repair and valve replacement modalities, highlighting the devices, techniques, and valves currently under investigation, summarizing available outcomes data for each modality when possible.

Results and Conclusion

Our aim in writing this landscape review is the create an all-encompassing, up-to-date resource for clinicians to refer to when seeking to learn about the current state of transcatheter tricuspid valve interventions. We also hope to highlight the exciting promise of transcatheter tricuspid valve replacement in appropriate patients, and review the valves currently under development for use in the tricuspid position.

KEYWORDS:

• Tricuspid regurgitation
• transcatheter tricuspid valve repair
• edge-to-edge repair
• Annulus-Reshaping

Article Highlights

• Tricuspid regurgitation is a prevalent and undertreated valvular disease

• Severe tricuspid regurgitation is an independent predictor of increased morbidity and mortality

• Transcatheter tricuspid interventions are rapidly being developed, but often more challenging than left-sided valve interventions due to difficulty imaging the tricuspid valve and complex subvalvular anatomy.

• The two main modalities for transcatheter tricuspid valve repair are leaflet-directed interventions and annular-reshaping interventions. Many devices have been developed and are under investigation for both strategies.

• Tricuspid valve replacement is an upcoming transcatheter therapy for select patients with tricuspid regurgitation.-–—

• Tricuspid valve replacement holds several distinct advantages over tricuspid valve repair, including complete elimination of tricuspid regurgitation, allowing for potential future valve-in-valve procedures, and annulus morphology independence.

Declaration of interest

A Latib is a consultant for Medtronic, Abbott, and Edwards Lifesciences. 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.