Abstract
Tricuspid valve disease, and particularly the management of severe tricuspid regurgitation
(TR), has gained momentum in recent years. Although it is well known that this frequent
condition is associated with poor clinical outcomes, these patients have been classically
managed medically, leading to end-stage right ventricular heart failure. Moreover,
late referral to surgery has contributed to a high rate of periprocedural complications
and in-hospital surgical mortality. Thus, the development of a less invasive catheter-based
therapy would be of high clinical relevance in this context. Several transcatheter
tricuspid valve intervention (TTVI) devices have been developed in recent years. The
particular characteristics of the tricuspid valve (large noncalcific annulus, presence
of chief surrounding structures such as the conduction system or the right coronary
artery) make multimodality imaging (eg, transesophageal echocardiography, computed
tomography) key in the preprocedural assessment of TTVI. According to their mechanism
of action and therapeutic target, TTVI includes transcatheter repair either with coaptation
or annuloplasty systems, caval valve devices, and transcatheter tricuspid valve replacement.
The initial TTVI experience showed that most procedures were well tolerated, with
high procedural success and low in-hospital and early mortality. Also, most TTVI recipients
improved their functional status and recent data suggest improved outcomes compared
with medical management. However, the rate of significant residual TR after transcatheter
tricuspid valve repair remains high and very scarce data exist on longer term (beyond
6-12 months) outcomes. The present review provides an overview regarding the framework
of chronic TR and TTVI therapeutic options, and describes the updated current evidence
in this challenging field.
Résumé
La valvulopathie tricuspidienne, et plus particulièrement la prise en charge d’une
insuffisance tricuspidienne sévère, reçoit plus d’attention ces dernières années.
Même s’il est bien connu que cette maladie fréquente est associée à une issue clinique
défavorable, elle a traditionnellement été prise en charge par des médicaments et
menait à une insuffisance cardiaque ventriculaire droite terminale. Par ailleurs,
l’orientation tardive en chirurgie a contribué à un taux élevé de complications périopératoires
et de mortalité postopératoire à l’hôpital. L’avènement d’un traitement moins invasif
par cathéter aurait donc une grande pertinence clinique dans ce contexte. Plusieurs
dispositifs permettant une intervention sur la valve tricuspide par voie transcathéter
(TTVI) ont été conçus depuis quelques années. Les caractéristiques particulières de
la valve tricuspide (grand anneau non calcifié, présence de structures avoisinantes
principales telles que le système de conduction ou l'artère coronaire droite) rendent
l’imagerie multimodalité (p. ex., échocardiographie transœsophagienne, tomodensitométrie)
essentielle dans l’évaluation préalable à une TTVI. Selon le mode d’action et la cible
thérapeutique, une TTVI comprend une réparation par voie transcathéter avec systèmes
de coaptation ou d’annuloplastie, la pose d’une valve dans la veine cave et un remplacement
transcathéter de la valve tricuspide. Les premières expériences de TTVI ont montré
que la plupart des interventions avaient été bien tolérées, que le taux de succès
avait été élevé et qu’il y avait eu peu de mortalité à l’hôpital et décès précoces.
De plus, l’état fonctionnel s’est amélioré chez la majorité des patients ayant subi
une TTVI, et des données récentes indiquent que les résultats seraient meilleurs qu’avec
une prise en charge médicale. Toutefois, le taux d'insuffisance tricuspidienne résiduelle
importante après une réparation de valve tricuspide par voie transcathéter demeure
élevé et il n’existe que de très rares données sur l’issue à plus long terme (au-delà
de 6 à 12 mois). La présente revue fournit un aperçu du cadre d'insuffisance tricuspidienne
chronique et d’options thérapeutiques en matière de TTVI, et décrit les données probantes
actualisées dans ce domaine complexe.
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Article info
Publication history
Published online: January 21, 2021
Accepted:
December 14,
2020
Received:
September 17,
2020
Footnotes
See page 965 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
