New Approaches to Treatment of Tricuspid Regurgitation

TL;DR

This paper explores new percutaneous treatments for tricuspid regurgitation, especially in high-risk patients where surgery is not feasible.

Contribution

The paper introduces and evaluates percutaneous devices for treating tricuspid regurgitation in high-risk patients.

Findings

Percutaneous devices show safety and effectiveness in treating severe tricuspid regurgitation.

Patient selection and proper clinical indications are crucial for successful outcomes.

Further randomized studies are needed to determine long-term benefits and risks.

Abstract

Tricuspid valve diseases are an increasing cause of cardiovascular mortality, peaking in the eighth decade of life. More than 75% of severe tricuspid regurgitations are recognized via functional mechanisms, often secondary to left heart disease and pulmonary hypertension. Surgical risk for isolated correction of tricuspid regurgitation, both repair or replacement, is associated with prohibitive risk mainly in elderly patients, with several comorbidities and right ventricular dysfunction. In the past decade, different percutaneous devices have been developed to treat a large group of high-surgical-risk patients. Early diagnosis and careful patient selection are essential to improving prognosis in severe TR. Potential treatment options may vary in different stages of disease. The current available results from present studies have proven the safety and effectiveness of these devices under proper clinical indications, although selection bias and non-randomization in most investigations at present do not allow for definite indications. Ideal anatomic and clinical parameters to predict interventional success are in continuous evolution and need definite standardization. We report three cases in which different percutaneous techniques were employed for treatment when surgery was not suitable. The literature is discussed for each condition. Despite promising results in terms of safety and success rate, further randomized studies are needed to better understand which patients may be subject to long-term effects on survival and quality of life.

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