Novel percutaneous tricuspid repair techniques

Introduction

The tricuspid valve apparatus is a complex and dynamic structure that interacts intricately with surrounding anatomy. The vast majority of patients with tricuspid valve disease have tricuspid valve regurgitation (TR), whereas a minority present with tricuspid stenosis (TS). TR represents a significant epidemiologic burden, with an estimated 1.6 million Americans affected by this condition and only 8000 tricuspid valve surgeries performed nationwide on a yearly basis. ^, Untreated severe TR is associated with poor outcomes from long-standing volume overload on the right ventricle (RV), with up to 36% 1-year mortality rate. In patients undergoing tricuspid valve surgery, 60% of patients received tricuspid valve replacement, while 40% underwent tricuspid valve repair. Despite the increase in surgical volumes, mortality remains high and unchanged, at 8% to 9%. The high mortality associated with tricuspid valve surgery is thought to be attributed to delayed referral for intervention, whereby irreversible RV dysfunction and end-organ damage have already ensued, increasing surgical risk. In patients who undergo tricuspid bioprosthetic valve replacement, over half require reintervention at 15 years due to prosthetic valve degeneration. Recently, percutaneous transcatheter tricuspid valve interventions have evolved as an option for patients who are at high risk for surgery and are the focus of this chapter.