The FORMA Repair System

A decade's summary of transcatheter tricuspid valve repair

Tricuspid regurgitation (TR) is the most common pathology for the tricuspid valve. Moderate to severe TR is associated with morbidity and adverse outcomes. The concept that TR resolves on its own if the underlying disease is successfully treated has proven to be false. Only a few patients with significant TR are deemed suitable for surgery. Given the late presentation of patients with high perioperative risks and substantial perioperative mortality, the development of transcatheter therapies and the experience gained with transcatheter aortic valve implantation operations have turned attention towards treating this challenging group of patients. In this article, we review the treatment options and highlight the role of transcatheter valve therapies in patients with severe TR.

Treatment of isolated tricuspid regurgitation in 2020: an update

Tricuspid valve regurgitation is an insidious pathology that is associated with increased mortality if left untreated. Conversely, surgical correction of tricuspid regurgitation is burdened by poor outcomes, especially when right ventricular dysfunction, kidney disease, or liver disease occur. There is, therefore, increasing interest in transcatheter approaches as an alternative to surgery in patients at high or prohibitive surgical risk. The development of percutaneous devices to treat tricuspid regurgitation has several technical challenges, mainly because of the complexity of valve anatomy, thus requiring accurate patient selection. Here we review the currently available transcatheter approaches to treat severe tricuspid regurgitation.

Current state of transcatheter tricuspid valve repair

Tricuspid regurgitation (TR) is a common valvular heart disease affecting >1.6 million people in the United States (US) and >70 million people worldwide. The age- and sex-adjusted prevalence of more than or equal to moderate TR in the US is estimated to be 0.55%. One-year mortality increases with increasing severity of TR. Yet, the majority of patients with severe TR are managed medically in the absence of another indication for cardiac surgery, and isolated tricuspid valve (TV) surgery remains infrequent. To address this unmet clinical need, various transcatheter TV therapies are now being developed as an alternative to surgery in extreme- and high-risk patients with severe functional TR. Transcatheter TV repair devices are aimed at improving leaflet coaptation either directly by bringing the leaflets together (leaflet/coaptation devices) or indirectly by repairing the dilated annulus (annuloplasty devices). In this review, we describe the current state of transcatheter TV repair therapies and summarize the available data on the efficacy and safety of various devices. Procedural and clinical outcomes of transcatheter TV repair therapies are expected to improve in the coming years with technological advancement, newer device iterations, and increased experience in this field. Appropriate patient selection, optimal timing of intervention, and evaluation of long-term outcomes and device durability will be key in ongoing and future studies.

Specific Anatomic Considerations for Tricuspid Interventions

PURPOSE OF REVIEW

This review discusses the normal anatomy and pathology of the tricuspid valve (TV) and right side of the heart. Emphasis is on those anatomic and pathologic features relevant to interventions intended to restore normal function to the TV in disease states.

RECENT FINDINGS

TV pathology is less common than aortic and mitral valve pathology, and treatment and outcomes for interventions face considerable hurdles. New innovations and early data showing safety and efficacy in transcatheter interventions have transformed TV interventions into the next frontier in cardiac valve disease treatment. Certain features of the TV and right heart have presented themselves as potential targets, as well as impediments, for TV intervention. The causes of TV pathology and the anatomy of the TV and right heart bring unique challenges to intervention. Approaches to intervention will continue to progress and change the way we view and treat TV pathology.