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Cardiology
Percutaneous Therapies for Tricuspid Valve Disease
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
10 sections · 113 slides
The forgotten valve
- Prevalence of tricuspid regurgitation
- Prognosis of significant tricuspid regurgitation
- Historical surgical experience in isolated tricuspid regurgitation
- Scope of transcatheter tricuspid therapy
Anatomic considerations
- Position and size of the tricuspid valve
- Components of the tricuspid valve apparatus
- Structure of the tricuspid annulus
- Dynamic behaviour of the tricuspid annulus
- Pattern of annular dilation in secondary TR
- Tricuspid leaflets
- Commissures and coaptation reserve
- Echocardiographic leaflet nomenclature
- Chordae tendineae
- Papillary muscles
- Structures adjacent to the tricuspid valve
- Venae cavae as access and landing zones
Mechanism and severity of tricuspid regurgitation
- Definition and mechanisms of tricuspid regurgitation
- Mechanisms of tricuspid regurgitation
- Classification of tricuspid regurgitation
- Causes of primary tricuspid regurgitation
- Secondary tricuspid regurgitation
- Vicious cycle in ventricular secondary TR
- Device lead related tricuspid regurgitation
- Classification of tricuspid regurgitation: mechanism
- Classification of tricuspid regurgitation: underlying reason
- Framework for grading TR severity
- Mild tricuspid regurgitation
- Moderate tricuspid regurgitation
- Severe tricuspid regurgitation
- Massive and torrential tricuspid regurgitation
- Five-grade scheme for tricuspid regurgitation severity
The right ventricle and imaging assessment
- Volume overload in chronic tricuspid regurgitation
- Pressure overload in tricuspid regurgitation
- Echocardiographic measures of RV function
- Right ventricular to pulmonary artery coupling
- Clinical implications of RV dysfunction
- Role of echocardiography in tricuspid regurgitation
- Two-dimensional and three-dimensional echocardiography
- Cardiac magnetic resonance and computed tomography
- Intracardiac echocardiography
- Multimodality imaging pathway
Indications and the heart team
- Guideline indications for isolated tricuspid valve surgery
- Indications for transcatheter tricuspid intervention
- Multidisciplinary heart team assessment
Transcatheter edge-to-edge repair
- Principle of transcatheter edge-to-edge repair
- Edge-to-edge repair devices
- TriClip system design
- PASCAL system design
- Edge-to-edge repair procedural sequence
- Step-by-step edge-to-edge repair with the TriClip device
- Techniques to reduce a large coaptation gap
- Zipping technique and choice of grasping site
- TRILUMINATE trial
- bRIGHT real-world registry
- Tri.Fr randomised controlled trial
- PASCAL evidence and the CLASP TR trial
Transcatheter annuloplasty
- Rationale for transcatheter annuloplasty
- Cardioband direct annuloplasty system
- Cardioband early feasibility outcomes
- TRI-REPAIR two-year outcomes
- K-Clip focal annuloplasty
Transcatheter tricuspid valve replacement
- Valve-in-valve and valve-in-ring replacement
- Preprocedural planning for valve-in-valve
- Access strategy for valve-in-valve procedures
- Transjugular valve-in-ring under echocardiographic guidance
- Crossing the failed prosthesis
- Valve selection for valve-in-valve
- Complications and outcomes of valve-in-valve
- Orthotopic transcatheter tricuspid valve replacement
- Transcatheter tricuspid valve replacement devices
- EVOQUE system design
- EVOQUE implantation: access and wire position
- EVOQUE implantation: crossing and coaxial alignment
- EVOQUE implantation: anchor release and valve expansion
- Step-by-step EVOQUE valve implantation
- Anchor engagement and staged valve expansion
- EVOQUE early feasibility study
- TRISCEND study
- TRISCEND II randomised trial
- Other replacement devices in development
Heterotopic caval valve implantation
- Principle of caval valve implantation
- TricValve system and the TRICUS EURO study
Patient selection and current limitations
- Favourable anatomy for tricuspid edge-to-edge repair
- Feasible but less favourable anatomy
- GLIDE score for procedural success
- Pulmonary pressure and haemodynamic assessment
- Anatomical limitations of transcatheter intervention
- Technical limitations of current devices
- Limited long-term data
- Challenges in patient selection
- Lack of standardised guidelines
- Conclusions
- Points to carry forward
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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