Tricuspid valve and percutaneous approach: No longer the forgotten valve!
Tricuspid valve disease is mainly represented by tricuspid regurgitation (TR), which is a predictor of poor outcome. TR is usually secondary, caused by right ventricle pressure or volume overload, the leading cause being left-sided heart valve diseases. Tricuspid surgery for severe TR is recommended during left valve surgery, and consists of either a valve replacement or, most often, a tricuspid repair with or without prosthetic annuloplasty. When TR persists or worsens after left valvular surgery, redo isolated tricuspid surgery is associated with high mortality. In addition, a sizeable proportion of patients present with tricuspid surgery deterioration over time, and need a reintervention, which is associated with high morbi-mortality rates. In this context, and given the recent major breakthrough in the percutaneous treatment of aortic and mitral valve diseases, the tricuspid valve appears an appealing challenge, although it raises specific issues. The first applications of transcatheter techniques for tricuspid valve disease were valve-in-valve and valve-in-ring implantation for degenerated bioprosthesis or ring annuloplasty. Some concerns remain regarding prosthesis sizing, rapid ventricular pacing and the best approach, but these procedures appear to be safe and effective. More recently, bicuspidization using a transcatheter approach for the treatment of native tricuspid valve has been published, in two patients. Finally, other devices are in preclinical development.
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, Paris, France. Electronic address: claire.bouleti@gmail.com.
Claire
C
Bouleti
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; DHU Fire, Paris-Diderot University, Paris, France; Inserm U-1148, Bichat Hospital, Paris, France.
Jean-Michel
JM
Juliard
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; DHU Fire, Paris-Diderot University, Paris, France; Inserm U-1148, Bichat Hospital, Paris, France.
Dominique
D
Himbert
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, Paris, France; Inserm U-1148, Bichat Hospital, Paris, France.
Bernard
B
Iung
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; DHU Fire, Paris-Diderot University, Paris, France.
Eric
E
Brochet
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; DHU Fire, Paris-Diderot University, Paris, France.
Marina
M
Urena
Department of Anaesthesiology, AP-HP, Bichat Hospital, Paris, France.
Marie-Pierre
MP
Dilly
Faculté de Médecine, Paris-Diderot University, Paris, France; Inserm U-1148, Bichat Hospital, Paris, France; Department of Radiology, AP-HP, Bichat Hospital, Paris, France.
Phalla
P
Ou
Faculté de Médecine, Paris-Diderot University, Paris, France; Inserm U-1148, Bichat Hospital, Paris, France; Department of Cardiac Surgery, AP-HP, Bichat Hospital, Paris, France.
Patrick
P
Nataf
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, Paris, France; Inserm U-1148, Bichat Hospital, Paris, France.
Alec
A
Vahanian
D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D058386:Mitral Valve Annuloplasty; D011474:Prosthesis Design; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
Heart valve prosthesis implantation; Implantation de prothèse valvulaire; Implantation valvulaire percutanée; Transcatheter valve implantation; Tricuspid valve; Valve tricuspide; Valvular heart diseases; Valvulopathies