Percutaneous tricuspid interventions
While tricuspid valve stenosis is a rarity, tricuspid regurgitation (T.I.) is a common valve disease. It contributes significantly to population morbidity and mortality.
Functional (or secondary) T.I. is the most common form. It is related to a complex interplay of left and proper heart function, pulmonary pressure, volume status, and right atrial size. The gold standard for diagnosis of T.I. is echocardiography. Right heart catheterization is essential because of its reliable pre-and postcapillary pulmonary pressures and their etiologic clarification. Current guidelines provide recommendations for surgical therapy of the tricuspid valve based on expert opinion. In particular, surgery for secondary T.I. is recommended only when there is an accompanying left heart surgical indication. However, the results of surgical therapy for isolated T.I. are suboptimal in terms of intrahospital mortality and durability of surgical outcome, mainly due to advanced age and associated comorbidities. Interventional transcatheter percutaneous approaches show promising results and raise the prospect of positively impacting morbidity and mortality in this complexly diseased patient population by providing a less invasive solution to a large number of symptomatic patients.
Several methods for transcatheter treatment of T.I. are available at our center, including transvenous valve repair with clip implantation (e.g., Triclip or Pascal) or valve replacement when the repair is not possible (Tricento prosthesis).
Transcatheter interventions on the tricuspid valve are usually performed via femoral venous access. They do not require transeptal puncture, providing a very high safety profile in this challenging situation. In addition, the patient can leave the hospital a few days after the procedure. Deciding which approach is best for each patient is based on a multidisciplinary discussion that considers anatomic and clinical factors. Each case is discussed in detail by our dedicated heart team.
In particular, the team performing a tricuspid intervention at our center has been actively involved in developing and applying these new procedures from the beginning. It is one of the most experienced teams in Europe in this field.
Our specialists can assess each clinical case and suggest the most appropriate approach for the individual patient.