From the Guidelines
The correct answer is "Valve replacement and repair." Percutaneous therapies for tricuspid valve disease currently include both valve repair and replacement techniques. According to the most recent study 1, several less-invasive investigational therapies have been developed and are undergoing clinical trial evaluation, including valve replacement. While valve repair techniques, such as edge-to-edge repair systems and annuloplasty devices, are currently available, valve replacement technologies are also being explored. The choice between repair or replacement depends on valve anatomy and surgical expertise, as stated in the 2017 ESC/EACTS guidelines for the management of valvular heart disease 1.
Some key points to consider when evaluating percutaneous therapies for tricuspid valve disease include:
- The anatomical challenges of the tricuspid valve, including its large annulus and proximity to the right coronary artery, which can make percutaneous replacement more challenging than repair.
- The lack of targeted treatments for tricuspid regurgitation, but medical therapies like diuretic agents and afterload reduction with pulmonary vasodilators can be useful in providing symptomatic relief, as mentioned in the 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology 1.
- The importance of considering the appropriate timing and indications for surgical intervention in patients with both asymptomatic and symptomatic disease, as well as the influence of right ventricular failure and tricuspid annular dilatation on this decision.
Overall, the most recent and highest quality study 1 suggests that both valve repair and replacement are being explored as percutaneous therapies for tricuspid valve disease, and the choice between them depends on individual patient factors and valve anatomy.
From the Research
Percutaneous Therapies for Tricuspid Valve
- The correct answer is: Valve replacement and repair
Rationale
- Percutaneous therapies for tricuspid valve disease include valve replacement and repair, as stated in studies 2, 3, 4
- Tricuspid valve repair using transcatheter techniques, such as valve-in-valve and valve-in-ring implantation, has been shown to be safe and effective 2
- Other percutaneous transcatheter options for tricuspid valve repair include annuloplasty systems, leaflet and coaptation devices, and tricuspid valve replacement 4
- The TriClip device is an example of a percutaneous edge-to-edge repair therapy for tricuspid regurgitation 5
Types of Percutaneous Therapies
- Valve-in-valve and valve-in-ring implantation for degenerated bioprosthesis or ring annuloplasty 2
- Bicuspidization using a transcatheter approach for the treatment of native tricuspid valve 2
- Tricuspid valve replacement, including orthotopic and heterotopic valves 4
- Edge-to-edge repair using devices such as the TriClip 5