Transcatheter tricuspid valve intervention
transcatheter tricuspid valve intervention (TTVI) has emerged as an
attractive alternative approach for inoperable or high surgical risk
candidates (STS-PROM >8%)32 who cannot
be submitted to a conventional open cardiac surgery.
Current available devices are designed for different anatomical and
functional purposes, as follow (adapted from
Curio
J et al. and Kolte D et al.)33,34:
1) Leaflet approximation or coaptation [MitraClip in the Tricuspid
Position (Figure 3) or TriClip (Abbott Vascular, Santa Clara, CA, USA),
Pascal system (Edwards Lifesciences Corp, Irvine, CA, USA),
TriCinchTM Coil System (4Tech Cardio, Galway,
Ireland), FormaTM Repair System (Edwards
Lifesciences)];
2) Annuloplasty [Cardioband® Tricuspid Repair System (Edwards
Lifesciences), IRIS Transcatheter Annuloplasty Ring (Millipede Inc,
Santa Rosa, CA, USA), Trialign device (Mitralign Inc., Tewksbury, Mass.,
USA)];
3) Orthotopic [GATETM system self-expanding
bioprosthesis (NaviGate Cardiac Structures, Lake Forest, CA, USA)] or
heterotopic [Heterotopic caval valve implantation using the SAPIEN
(Edwards Lifesciences Corp, Irvine, CA, USA), or the TricValve®
(P&F Products GmbH, Vienna, Austria) systems].
In TTVI trials, technical feasibility and safety was proven, and TTVI
showed a low periprocedural mortality (30-day mortality =
3.6%)35, even when performed in high-surgical risk
patients. Nonetheless, Taramasso et al. recently suggested an important
benefit in terms of survival and rehospitalization rates when TTVI was
compared with medical therapy [1-year mortality: 23 ± 3% vs 36 ± 3%
in TTVI versus control group, respectively; p=0.001); 1-year
rehospitalization: 26 ± 3% vs 47 ± 3%, in TTVI versus control group,
respectively; p<0.0001)36.