Patient selection, echocardiographic screening and treatment strategies for interventional tricuspid repair using the edge-to-edge repair technique

Jörg Hausleiter, Daniel Braun, Mathias Orban, Azeem Latib, Philipp Lurz, Peter Boekstegers, Ralph Stephan Von Bardeleben, Marek Kowalski, Rebecca T. Hahn, Francesco Maisano, Christian Hagl, Steffen Massberg, Michael Nabauer

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Severe tricuspid regurgitation (TR) has long been neglected despite its well-known association with mortality. While surgical mortality rates remain high in isolated tricuspid valve surgery, interventional TR repair is rapidly evolving as an alternative to cardiac surgery in selected patients at high surgical risk. Currently, interventional edge-to-edge repair is the most frequently applied technique for TR repair even though a device has not been developed for this particular indication. Due to the inherent differences in tricuspid and mitral valve anatomy and pathology, percutaneous repair of the tricuspid valve is challenging due to a variety of factors including the complexity and variability of tricuspid valve anatomy, echocardiographic visibility of the valve leaflets, and device steering to the tricuspid valve. Furthermore, it remains to be clarified which patients are suitable for a percutaneous tricuspid repair and which features predict a successful procedure. On the basis of the available experience, we describe criteria for patient selection including morphological valve features, a standardised process for echocardiographic screening, and a strategy for clip placement. These criteria will help to achieve standardisation of valve assessment and the procedural approach, and to develop interventional tricuspid valve repair further, using either currently available devices or dedicated tricuspid edge-to-edge repair devices in the future. In summary, this manuscript will provide guidance for patient selection and echocardiographic screening when considering edge-to-edge repair for severe TR.

Original languageEnglish (US)
Pages (from-to)645-653
Number of pages9
JournalEuroIntervention
Volume14
Issue number6
DOIs
StatePublished - Aug 2018
Externally publishedYes

Keywords

  • Chronic heart failure
  • Transoesophageal echocardiogram
  • Tricuspid disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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