INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

TRICUSPID VALVE IN VALVE/VALVE IN RING THERAPY

Özkan Eravcı

Gülhane Training and Research Hospital, Department of Cardiology, Ankara, Türkiye

Eravcı Ö. Tricuspid Valve in Valve/ Valve in Ring Therapy. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.341-350.

ABSTRACT

Tricuspid valve diseases are generally defined by stenosis, regurgitation, or a mix of the two. Tricuspid regurgitation is more prevalent and is typically attributed to left-sided cardiac diseases. Recent studies indicate that secondary (functional) tricuspid regurgitation significantly affects mortality and morbidity, heightening interest in tricuspid valve intervention. Tricuspid valve surgery involves substituting the natural valve with a prosthetic valve or utilizing an annuloplasty ring or band to constrict a dilated tricuspid annulus, therefore approximating the valve leaflets and decreasing the extent of regurgitation. Five-year follow-up statistics post-tricuspid valve surgery indicate that around one-third of patients experience valve dysfunction. Transcatheter tricuspid valve-in-valve and valve-in-ring procedures may be considered for patients with dysfunctional tricuspid bioprosthetic valves or annuloplasty rings, particularly those exhibiting NYHA class III–IV functional impairment, possessing elevated surgical risk scores (e.g. STS, EuroSCORE II), and facing heightened reoperation mortality, as long as they do not present with advanced right ventricular dysfunction or severe pulmonary hypertension . In recent years, various companies have been developing transcatheter valves and devices, with a special emphasis on tricuspid implantation. For example, the EVOQUE Valve (Edwards Lifesciences, Irvine, California) and the NaviGate bioprosthesis (NaviGate CardiacStructures Inc. Irvine, California) are valves used for this purpose. Novel approaches designed for the tricuspid valve remain at the clinical research phase, have restricted use, and have not yet achieved worldwide adoption. Currently, transcatheter valves originally designed for other valve positions are predominantly used. Globally, the Melody valve (Medtronic, Minnepolis, MN, USA) and the Sapien 3 (Edwards Lifescience, Irvıne, CA, USA) are the most often used devices in transcatheter valve-in-valve and valve-in-ring procedures. Current research demonstrates that these methods are both safe and effective in the short to intermediate term. A thorough preprocedural assessment of anatomy and lesions, suitable valve selection, a collaborative approach by a skilled team in the catheterization laboratory, and meticulous post-procedural monitoring collectively result in significantly enhanced patient outcomes.

Keywords: Tricuspid regurgitation; Cardiac valve prosthesis; Transcatheter heart valve; Transthoracic echocardiography; Fluoroscopy

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