Transcatheter Therapies for Treating Tricuspid Regurgitation

• Published in: Journal of the American College of Cardiology Vol. 67; no. 15; pp. 1829 - 1845
• Main Authors: Rodés-Cabau, Josep, Hahn, Rebecca T., Latib, Azeem, Laule, Michael, Lauten, Alexander, Maisano, Francesco, Schofer, Joachim, Campelo-Parada, Francisco, Puri, Rishi, Vahanian, Alec
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 19.04.2016; Elsevier Limited
• Subjects: cardiac catheterization; Cardiac Catheterization - methods; Cardiology; Cardiovascular; Cardiovascular disease; Disease Progression; echocardiography; Echocardiography - methods; Heart attacks; Heart failure; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Hospital Mortality; Hospitals; Humans; Hypertension; Mortality; pulmonary hypertension; right ventricular dysfunction; Risk Adjustment; Severity of Illness Index; Surgery; Time-to-Treatment; tricuspid valve; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - physiopathology; Tricuspid Valve - surgery; tricuspid valve insufficiency; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - surgery; NYHA; SVC; TV; tricuspid valve; RV; TTE; pulmonary hypertension; echocardiography; CMR; MDCT; TA; CAVI; 3D; CT; ASE; cardiac catheterization; TEE; PAH; IVC; right ventricular dysfunction; tricuspid valve insufficiency; TR; EROA; tricuspid valve annulus; New York Heart Association; right ventricle/ventricular; tricuspid regurgitation; multidetector computed tomography; effective regurgitant orifice area; 3-dimensional; pulmonary arterial hypertension; computed tomography; transthoracic echocardiography; caval valve implantation; inferior vena cava; superior vena cava; transesophageal echocardiography; American Society of Echocardiography; cardiac magnetic resonance
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2016.01.063

Tricuspid valve (TV) disease has been relatively neglected, despite the known association between severe tricuspid regurgitation (TR) and mortality. Few patients undergo isolated tricuspid surgery, which remains associated with high in-hospital mortality rates, particularly in patients with prior left-sided valve surgery. Patients with severe TR are often managed medically for years before TV repair or replacement. Current guidelines recommend TV repair in the presence of a dilated tricuspid annulus at the time of a left-sided valve surgical intervention, even if regurgitation is mild. This proposed algorithm aims to prevent the inevitable progression to severe TR and the need for a second surgical intervention. Recently, novel transcatheter treatment options were developed for treating patients with severe TR and right heart failure with prohibitive surgical risk. Here we describe currently available transcatheter treatment options for severe TR implanted at different levels: the junction between vena cavae and right atrium; the tricuspid annulus; or between TV leaflets, improving coaptation.