19 Nov 2021
State-of-the-art: Transcatheter treatment for tricuspid valve disease
Selected in EuroIntervention
The development and successful results of transcatheter aortic valve implantation, followed by transcatheter therapies for mitral valve disease have opened a myriad of opportunities for transcatheter treatment of TR. Read this State-of-the-Art paper published in EuroIntervention by the PCR Tricuspid Focus Group.
References
Authors
Fabien Praz, Denisa Muraru, Felix Kreidel, Philipp Lurz, Rebecca T. Hahn, Victoria Delgado, Michele Senni, Ralph Stephan von Bardeleben, Georg Nickenig, Jörg Hausleiter, Antonio Mangieri, Jose L. Zamorano, Bernard D. Prendergast and Francesco Maisano
Reference
10.4244/EIJ-D-21-00695
Link
Read the abstractAbstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation.
Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation.
The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
Source EuroIntervention: Care pathways for patients with severe tricuspid regurgitation. 2D: two-dimensional; 3D: three-dimensional; CCT: cardiac computed tomography; CMR: cardiac magnetic resonance; ECG: electrocardiogram; HF: heart failure; M-TEER: mitral transcatheter edge-to-edge reapair; PH: pulmonary hypertension; TAVI: transcatheter aortic valve implantation; TR: tricuspid regurgitation
On the same subject: An interview with Rebecca Hahn by Alessandro Sticchi
