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.