Insight into tricuspid transcatheter edge-to-edge repair: no longer the forgotten valve

ABSTRACT

Introduction

Tricuspid regurgitation (TR) is one of the most prevalent types of valvular heart disease linked to poor prognosis in patients with heart failure and is usually ignored. TR has received considerable attention due to the progressive advancements in transcatheter therapies in recent years.

Areas covered

With relatively solid data and rapid technological advancements, tricuspid transcatheter edge-to-edge repair (T-TEER) is the most frequently employed in a series of tricuspid transcatheter interventional treatments for TR. However, the efficacy and technical benefits of T-TEER are limited because of the unique anatomical characteristics and pathological mechanisms of the tricuspid valve. The aim of this review is to summarize reported data on current status of T-TEER and to provide an expert opinion regarding the challenges it is now experiencing and future development direction and approach.

Expert opinion

T-TEER is a significant treatment for TR, but its effectiveness and technical promotion are limited due to the tricuspid valve unique anatomical characteristics and pathological mechanisms. The selection criteria for suitable patients, the choice of when to intervene, device innovation, the advancement of ultrasound technology, and the volume of evidence in evidence-based medicine all indicate that the disorder of TR will eventually be better treated and understood.

KEYWORDS:

• Tricuspid regurgitation
• tricuspid repair
• tricuspid transcatheter intervention
• transcatheter edge-to-edge repair
• coaptation devices

Article highlights

• Results from current interventional trials show that T-TEER treatment for severe TR patients significantly improves quality of life, hospitalization rate, and survival rates.

• T-TEER is a significant treatment for TR, but its effectiveness and technical promotion are limited due to the tricuspid valve unique anatomical characteristics and pathological mechanisms.

• Coaptation devices, such as PASCAL and MitraClip, have been employed to ameliorate TR through valve leaflet plication. New versions of devices have been developed with improved distribution methods or specially built clips to make it easier to navigate the TV anatomy: the TriClip and PASCAL Ace systems.

• Future resolution of TR requires screening criteria, intervention timing, device innovation, ultrasound technology development, and further evidence-based medicine.

Declaration of interest

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.

Reviewer disclosures

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

Additional information

Funding

This paper was funded by Jiangsu Provincial Medical Key Discipline (Laboratory) [NO. ZDXK202207].