Materiały źródłowe

• #1 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Tricuspid regurgitation (TR) is a common finding in the general population. Significant TR is associated with a higher cardiovascular mortality. TR is still underestimated and transcatheter treatment options underutilised. […] Early referral for assessment and treatment of TR is essential. Transcatheter techniques are safe and efficient in reducing TR and improving symptoms of heart failure. Multiple transcatheter techniques are available for TR treatment and appropriate device selection based on tricuspid valve anatomy is necessary for optimal procedural results. […] Guideline-directed medical therapy is the cornerstone and first step of tricuspid regurgitation (TR) treatment, along with addressing comorbidities, such as left-sided valvular diseases, coronary artery disease, cardiomyopathy, pulmonary diseases, or atrial fibrillation. Diuretics are particularly effective in reducing systemic volume overload and alleviating symptoms related to right heart failure. However, when TR progresses or heart failure symptoms persist despite the optimal medical therapy, interventional strategies for TR treatment should be considered especially in case of secondary TR associated with progressive heart failure with unfavourable outcomes. Interdisciplinary discussion within an experienced Heart Team is crucial. Surgical tricuspid valve (TV) reconstruction is generally preferred over replacement and minimally invasive beating-heart endoscopic techniques are rapidly developing.

• #2 The Diagnosis and Treatment of Tricuspid Regurgitation (23.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240811

  Background: It is estimated that 6% of persons over age 75 have clinically relevant tricuspid regurgitation (TR). This condition carries a high mortality and is of particular interest because of the recent development of new interventional treatments. […] The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). Early referral to a specialized heart valve center is essential for the prevention of irreversible damage of the right heart and secondary end-organ damage, including cardiohepatic and cardiorenal syndromes. […] The first randomized controlled trial of treatment for TR yielded a win ratio of 1.48 (95% confidence interval, [1.06; 2.13]) for interventional treatment (edge-to-edge repair) compared to optimal medical therapy. […] As the understanding of tricuspid regurgitation improves, strategies for its interventional treatment are undergoing steady development, with the aim of lowering the mortality of this condition.

• #3 Tricuspid valve regurgitation | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20120486/

  Mild tricuspid valve regurgitation may not cause symptoms or require treatment. If the condition is severe and causing symptoms, medicine or surgery may be needed. […] Treatment for tricuspid valve regurgitation depends on the cause and how severe it is. The goals of treatment are to: Help the heart work better. Reduce symptoms. Improve quality of life. Prevent complications. […] Tricuspid regurgitation treatment may include: Medicines. A heart procedure. Surgery to repair or replace the heart valve. […] Your healthcare professional may suggest medicines to control symptoms of tricuspid valve regurgitation. Medicines also may be used to treat the cause. […] Surgery may be needed to repair or replace a diseased or damaged tricuspid valve. […] Tricuspid valve repair or replacement may be done as open-heart surgery or as a minimally invasive heart surgery.

• #4 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is. […] Treatment may include: Regular health checkups. Medicines. Surgery to fix or replace the valve. […] If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working. […] Medicine may be used to treat: The underlying cause of tricuspid valve disease. Complications such as heart failure. […] For example, diuretics, also called water pills, may be given to help remove fluid from the body. […] If a current infection causes tricuspid valve disease, antibiotics are usually given. […] If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms. […] If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

• #5 The Diagnosis and Treatment of Tricuspid Regurgitation (23.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240811

  Background: It is estimated that 6% of persons over age 75 have clinically relevant tricuspid regurgitation (TR). This condition carries a high mortality and is of particular interest because of the recent development of new interventional treatments. […] The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). Early referral to a specialized heart valve center is essential for the prevention of irreversible damage of the right heart and secondary end-organ damage, including cardiohepatic and cardiorenal syndromes. […] The first randomized controlled trial of treatment for TR yielded a win ratio of 1.48 (95% confidence interval, [1.06; 2.13]) for interventional treatment (edge-to-edge repair) compared to optimal medical therapy. […] As the understanding of tricuspid regurgitation improves, strategies for its interventional treatment are undergoing steady development, with the aim of lowering the mortality of this condition.

• #6 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Tricuspid regurgitation (TR) is a common finding in the general population. Significant TR is associated with a higher cardiovascular mortality. TR is still underestimated and transcatheter treatment options underutilised. […] Early referral for assessment and treatment of TR is essential. Transcatheter techniques are safe and efficient in reducing TR and improving symptoms of heart failure. Multiple transcatheter techniques are available for TR treatment and appropriate device selection based on tricuspid valve anatomy is necessary for optimal procedural results. […] Guideline-directed medical therapy is the cornerstone and first step of tricuspid regurgitation (TR) treatment, along with addressing comorbidities, such as left-sided valvular diseases, coronary artery disease, cardiomyopathy, pulmonary diseases, or atrial fibrillation. Diuretics are particularly effective in reducing systemic volume overload and alleviating symptoms related to right heart failure. However, when TR progresses or heart failure symptoms persist despite the optimal medical therapy, interventional strategies for TR treatment should be considered especially in case of secondary TR associated with progressive heart failure with unfavourable outcomes. Interdisciplinary discussion within an experienced Heart Team is crucial. Surgical tricuspid valve (TV) reconstruction is generally preferred over replacement and minimally invasive beating-heart endoscopic techniques are rapidly developing.

• #7 Medications for Heart Valve Symptoms | American Heart Association

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/medications-for-heart-valve-symptoms

  People who are diagnosed with heart valve disease may be prescribed medications to help relieve symptoms and decrease the risk of further problems. […] Although medications can serve a very important purpose, there is no medication that will stop a valve from leaking. Likewise, there’s no medication that will open a valve that’s too constricted. […] Still, there are times when the medication is determined to be the best course of action. This decision may be most appropriate for someone whose valve condition is very mild or for a person for whom surgery is not an option. […] If your valve disease progresses, surgical treatment may be necessary. Your health care team can help you understand and evaluate options for heart valve repair or valve replacement surgery.

• #8 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is. […] Treatment may include: Regular health checkups. Medicines. Surgery to fix or replace the valve. […] If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working. […] Medicine may be used to treat: The underlying cause of tricuspid valve disease. Complications such as heart failure. […] For example, diuretics, also called water pills, may be given to help remove fluid from the body. […] If a current infection causes tricuspid valve disease, antibiotics are usually given. […] If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms. […] If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

• #9 Tricuspid Regurgitation Medication: Diuretics, Antidysrhythmics, V, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Cardiovascular

  https://emedicine.medscape.com/article/158484-medication

  The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation. […] Diuretics are used to control the fluid overload associated with tricuspid regurgitation. […] These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility. […] ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle. […] In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.

• #10 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  For patients in whom tricuspid regurgitation is secondary to left-sided heart failure, treatment centers on adequate control of fluid overload and failure symptoms (eg, diuretic therapy). Patients should be instructed to reduce their intake of salt. Elevation of the head of the bed may improve symptoms of shortness of breath. […] Digitalis, diuretics (including potassium-sparing agents), angiotensin-converting enzyme (ACE) inhibitors, and anticoagulants are all indicated in the care of these patients. Antiarrhythmics are added as needed to control atrial fibrillation. […] The need for correction of tricuspid regurgitation is usually considered at the time of surgical correction of left-sided valve lesions. Severe regurgitation has been successfully treated with tricuspid annuloplasty. Long-term results with prosthetic rings are superior to those achieved with suture annuloplasty.

• #11 Tricuspid Regurgitation Medication: Diuretics, Antidysrhythmics, V, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Cardiovascular

  https://emedicine.medscape.com/article/158484-medication

  The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation. […] Diuretics are used to control the fluid overload associated with tricuspid regurgitation. […] These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility. […] ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle. […] In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.

• #12 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is. […] Treatment may include: Regular health checkups. Medicines. Surgery to fix or replace the valve. […] If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working. […] Medicine may be used to treat: The underlying cause of tricuspid valve disease. Complications such as heart failure. […] For example, diuretics, also called water pills, may be given to help remove fluid from the body. […] If a current infection causes tricuspid valve disease, antibiotics are usually given. […] If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms. […] If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

• #13 Tricuspid valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/diagnosis-treatment/drc-20350173

  Treatment for tricuspid valve regurgitation depends on the cause and how severe it is. The goals of treatment are to: […] Tricuspid regurgitation treatment may include: […] Medicines. […] A heart procedure. […] Surgery to repair or replace the heart valve. […] Your healthcare professional may suggest medicines to control symptoms of tricuspid valve regurgitation. Medicines also may be used to treat the cause. […] Some medicines used for tricuspid valve regurgitation are: […] Diuretics. […] Potassium-sparing diuretics. […] Other medicines to treat or control heart failure. […] Medicines to control irregular heartbeats. […] Surgery may be needed to repair or replace a diseased or damaged tricuspid valve. […] Tricuspid valve repair or replacement may be done as open-heart surgery or as a minimally invasive heart surgery.

• #14 Tricuspid Regurgitation Medication: Diuretics, Antidysrhythmics, V, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Cardiovascular

  https://emedicine.medscape.com/article/158484-medication

  The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation. […] Diuretics are used to control the fluid overload associated with tricuspid regurgitation. […] These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility. […] ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle. […] In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.

• #15 Tricuspid Valve Regurgitation Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/tricuspid-valve-regurgitation/treatment-options

  Your doctor may suggest lifestyle changes and medication to help manage some of the symptoms of tricuspid valve regurgitation. In moderate or severe cases, surgery may be needed. […] Medications may be prescribed to reduce blood pressure (e.g., beta blockers, diuretics, ACE inhibitors) or to manage heart failure; occasionally, antibiotics are given to reduce infection risk before dental or medical procedures; after valve replacement, blood thinners are prescribed to prevent stroke. […] For those with moderate to severe symptoms of regurgitation or with risk of heart failure the valve is often repaired. When the valve needs to be replaced, this is done using a mechanical or tissue (from pig, cow, or human donor) valve. Surgical therapies include: […] Complex tricuspid valve repair and replacement procedures for patients with severe disease.

• #16 Tricuspid valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/diagnosis-treatment/drc-20350173

  Treatment for tricuspid valve regurgitation depends on the cause and how severe it is. The goals of treatment are to: […] Tricuspid regurgitation treatment may include: […] Medicines. […] A heart procedure. […] Surgery to repair or replace the heart valve. […] Your healthcare professional may suggest medicines to control symptoms of tricuspid valve regurgitation. Medicines also may be used to treat the cause. […] Some medicines used for tricuspid valve regurgitation are: […] Diuretics. […] Potassium-sparing diuretics. […] Other medicines to treat or control heart failure. […] Medicines to control irregular heartbeats. […] Surgery may be needed to repair or replace a diseased or damaged tricuspid valve. […] Tricuspid valve repair or replacement may be done as open-heart surgery or as a minimally invasive heart surgery.

• #17 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  For patients in whom tricuspid regurgitation is secondary to left-sided heart failure, treatment centers on adequate control of fluid overload and failure symptoms (eg, diuretic therapy). Patients should be instructed to reduce their intake of salt. Elevation of the head of the bed may improve symptoms of shortness of breath. […] Digitalis, diuretics (including potassium-sparing agents), angiotensin-converting enzyme (ACE) inhibitors, and anticoagulants are all indicated in the care of these patients. Antiarrhythmics are added as needed to control atrial fibrillation. […] The need for correction of tricuspid regurgitation is usually considered at the time of surgical correction of left-sided valve lesions. Severe regurgitation has been successfully treated with tricuspid annuloplasty. Long-term results with prosthetic rings are superior to those achieved with suture annuloplasty.

• #18 Tricuspid Valve Disease: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17578-tricuspid-valve-disease

  Tricuspid valve disease is a problem with the valve between the hearts right atrium and right ventricle. Treatment ranges from monitoring to medications to surgery. […] If the tricuspid valve doesnt work properly, you may need monitoring or valve repair or replacement. […] Your healthcare provider may recommend certain medications to ease the symptoms or prevent complications: Anti-arrhythmic medications, Angiotensin-converting enzyme (ACE) inhibitors, Anticoagulants, Digoxin to treat heart failure, Diuretics (water pills) to remove extra fluid from the body. […] Advanced or severe cases may require tricuspid valve surgery to repair or replace the valve. […] The outlook with tricuspid valve disease is generally good. Many people manage with regular follow-up appointments and medications. When needed, surgical repair or replacement usually corrects the condition. […] If you’re experiencing signs like general fatigue, weakness, swelling or fluttering, talk to your primary care provider or a cardiologist. They may recommend monitoring the condition, medication to manage symptoms or surgery to repair or replace the valve.

• #19 Tricuspid Regurgitation Medication: Diuretics, Antidysrhythmics, V, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Cardiovascular

  https://emedicine.medscape.com/article/158484-medication

  The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation. […] Diuretics are used to control the fluid overload associated with tricuspid regurgitation. […] These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility. […] ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle. […] In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.

• #20 Tricuspid Valve Disease: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17578-tricuspid-valve-disease

  Tricuspid valve disease is a problem with the valve between the hearts right atrium and right ventricle. Treatment ranges from monitoring to medications to surgery. […] If the tricuspid valve doesnt work properly, you may need monitoring or valve repair or replacement. […] Your healthcare provider may recommend certain medications to ease the symptoms or prevent complications: Anti-arrhythmic medications, Angiotensin-converting enzyme (ACE) inhibitors, Anticoagulants, Digoxin to treat heart failure, Diuretics (water pills) to remove extra fluid from the body. […] Advanced or severe cases may require tricuspid valve surgery to repair or replace the valve. […] The outlook with tricuspid valve disease is generally good. Many people manage with regular follow-up appointments and medications. When needed, surgical repair or replacement usually corrects the condition. […] If you’re experiencing signs like general fatigue, weakness, swelling or fluttering, talk to your primary care provider or a cardiologist. They may recommend monitoring the condition, medication to manage symptoms or surgery to repair or replace the valve.

• #21 Tricuspid Regurgitation Medication: Diuretics, Antidysrhythmics, V, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Cardiovascular

  https://emedicine.medscape.com/article/158484-medication

  The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation. […] Diuretics are used to control the fluid overload associated with tricuspid regurgitation. […] These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility. […] ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle. […] In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.

• #22 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is. […] Treatment may include: Regular health checkups. Medicines. Surgery to fix or replace the valve. […] If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working. […] Medicine may be used to treat: The underlying cause of tricuspid valve disease. Complications such as heart failure. […] For example, diuretics, also called water pills, may be given to help remove fluid from the body. […] If a current infection causes tricuspid valve disease, antibiotics are usually given. […] If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms. […] If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

• #23 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  The choice of treatment for tricuspid regurgitation depends on the etiology and severity of the condition. Medical therapy may be used in tricuspid regurgitation secondary to left-sided heart failure. With mild tricuspid regurgitation associated with mitral valve disease and pulmonary hypertension, the tricuspid regurgitation itself does not require intervention. As pulmonary vascular pressures fall with successful mitral valve therapy, the tricuspid regurgitation tends to disappear. […] Surgical options include annuloplasty and valve replacement. Indications for surgical intervention include the following: Structural deformity of the valve (eg, Ebstein anomaly), Destruction of the valve by bacterial endocarditis, Severe ventricular dilatation that is uncontrolled with medical therapy. […] In a recent study, investigators evaluated a novel transcatheter repair system for the treatment of severe tricuspid regurgitation. They treated seven high-risk patients with severe tricuspid regurgitation and clinical signs of heart failure, who were declined for surgery, with the transcatheter repair system. All patients showed improvements in the severity of tricuspid regurgitation, as well as improvements in peripheral edema and functional status.

• #24 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is. […] Treatment may include: Regular health checkups. Medicines. Surgery to fix or replace the valve. […] If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working. […] Medicine may be used to treat: The underlying cause of tricuspid valve disease. Complications such as heart failure. […] For example, diuretics, also called water pills, may be given to help remove fluid from the body. […] If a current infection causes tricuspid valve disease, antibiotics are usually given. […] If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms. […] If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

• #25 The Diagnosis and Treatment of Tricuspid Regurgitation (23.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240811

  Optimization of the entire treatment process is necessary if the symptoms and prognosis of patients with TR are to be improved. In the outpatient setting, early detection of the disease followed by initiation of medical treatment and timely referral to a specialized heart valve center is of crucial importance. […] Diuretics should be used in patients with significant TR and clinical signs of right heart failure (class 2a recommendation). […] If significant and symptomatic TR persists despite optimal treatment of underlying conditions and medical therapy, one should weigh up whether specific tricuspid valve treatment is indicated. […] The best treatment in each individual case is decided by a multidisciplinary heart team. […] To date, the only evidence from randomized controlled trials is for interventional treatments. These include edge-to-edge repair by means of clipping and interventional tricuspid valve replacement with the Evoque system.

• #26 Transcatheter tricuspid valve intervention techniques and procedural steps for the treatment of tricuspid regurgitation: a review of the literature | Open Heart

  https://openheart.bmj.com/content/9/1/e002030

  Severe tricuspid regurgitation (TR) is an undertreated common pathology associated with significant morbidity and mortality. Classically, surgical repair or valve replacement were the only therapeutic options and are associated with up to 10% postprocedural mortality. Transcatheter tricuspid valve interventions are a novel and effective therapeutic option for the treatment of significant TR. Several devices have been developed with different mechanisms of action. They are classified as annuloplasty devices, replacement devices, caval valve implantation and coaptation devices. […] The disease currently has limited treatment options that are challenging, themselves. The management of TR includes medical, surgical and percutaneous interventional treatments. Medical therapy for the management of severe TR is often limited and mainly targets symptom relief. Furthermore, surgical replacement or repair is associated with a high rate of complications and an in-hospital mortality reaching up to 10% especially in patients with previous left-sided heart valve surgery or previous tricuspid repair.

• #27 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  This treatment may be done if you have tricuspid stenosis. A doctor places a thin tube with a balloon on the end into a blood vessel and guides it to the heart. Once in place, the balloon inflates. This makes the valve opening wider, improving blood flow. The catheter and balloon are removed. […] Tricuspid valve repair and tricuspid valve replacement are types of heart surgery. They can help improve blood flow and reduce symptoms. […] The type of tricuspid valve surgery needed depends on: The symptoms. How severe tricuspid valve disease is, also called the stage. Age and overall health. Whether the condition is getting worse. Whether surgery is needed to correct another valve or heart condition. […] Surgeons do tricuspid valve repair when possible. Repair saves the heart valve and improves how the heart works. Tricuspid valve repair is usually done with open-heart surgery. Sometimes, a tricuspid valve can be repaired with minimally invasive heart surgery or a procedure using thin tubes called catheters and a clip.

• #28 Tricuspid valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/diagnosis-treatment/drc-20350173

  Sometimes, tricuspid valve disease may be treated with a catheter-based procedure. The treatment can help improve blood flow and reduce symptoms of heart valve disease. […] You may need tricuspid valve repair or replacement surgery if: […] The valve disease is severe and you have symptoms such as shortness of breath. […] Your heart is growing larger or weaker, even if you don’t have symptoms of tricuspid regurgitation. […] You have tricuspid valve regurgitation and need heart surgery for another condition, such as mitral valve disease. […] Types of heart valve surgery to treat tricuspid regurgitation include: […] Tricuspid valve repair. […] Tricuspid valve replacement. […] Valve-in-valve replacement. […] After tricuspid repair or replacement, regular health checkups are needed to make sure the heart is working as it should.

• #29 Tricuspid valve regurgitation | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20120486/

  You may need tricuspid valve repair or replacement surgery if: The valve disease is severe and you have symptoms such as shortness of breath. Your heart is growing larger or weaker, even if you don’t have symptoms of tricuspid regurgitation. You have tricuspid valve regurgitation and need heart surgery for another condition, such as mitral valve disease. […] Types of heart valve surgery to treat tricuspid regurgitation include: Tricuspid valve repair. Surgeons recommend valve repair when possible. It saves the heart valve. It also may reduce the need for long-term use of blood thinners. […] Tricuspid valve replacement. If the tricuspid valve can’t be repaired, surgery may be needed to replace the valve. […] Valve-in-valve replacement. If you have a biological tissue tricuspid valve that’s no longer working, a catheter procedure may be done instead of open-heart surgery to replace the valve.

• #30 Tricuspid Regurgitation Medication: Diuretics, Antidysrhythmics, V, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Cardiovascular

  https://emedicine.medscape.com/article/158484-medication

  Tricuspid valve surgery for patients with severe tricuspid regurgitation(TR) or severe tricuspid stenosis (TS) when undergoing left-sided valve surgery. Class I […] Tricuspid valve surgery for patients with isolated, symptomatic severe TR without severe right ventricle dysfunction. Class I […] Tricuspid valve surgery for patients with symptoms due to severe primary TR that are unresponsive to medical therapy (stage D). Class IIa-Reasonable […] After left-sided valve surgery, surgery for patients with severe TR who are symptomatic or have progressive right ventricular dilatation/dysfunction, in the absence of left-sided valve dysfunction, severe right or left ventricular dysfunction, and severe pulmonary vascular disease. Class IIa-Reasonable […] Reoperation for isolated tricuspid valve repair or replacement for persistent symptoms due to severe TR (stage D) in patients who have undergone previous left-sided valve surgery and who do not have severe pulmonary hypertension or significant RV systolic dysfunction. Class IIb-Consider.

• #31 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  The choice of treatment for tricuspid regurgitation depends on the etiology and severity of the condition. Medical therapy may be used in tricuspid regurgitation secondary to left-sided heart failure. With mild tricuspid regurgitation associated with mitral valve disease and pulmonary hypertension, the tricuspid regurgitation itself does not require intervention. As pulmonary vascular pressures fall with successful mitral valve therapy, the tricuspid regurgitation tends to disappear. […] Surgical options include annuloplasty and valve replacement. Indications for surgical intervention include the following: Structural deformity of the valve (eg, Ebstein anomaly), Destruction of the valve by bacterial endocarditis, Severe ventricular dilatation that is uncontrolled with medical therapy. […] In a recent study, investigators evaluated a novel transcatheter repair system for the treatment of severe tricuspid regurgitation. They treated seven high-risk patients with severe tricuspid regurgitation and clinical signs of heart failure, who were declined for surgery, with the transcatheter repair system. All patients showed improvements in the severity of tricuspid regurgitation, as well as improvements in peripheral edema and functional status.

• #32 Tricuspid valve interventions: surgical techniques and outcomes | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-valve-interventions-surgical-techniques-and-outcomes

  The surgical treatment of isolated and concomitant tricuspid valve disease, especially functional tricuspid valve regurgitation, remains controversial. […] Surgical treatment of FTR in the context of left-sided valvular disease remains a matter of controversy with regard to accurate diagnosis, indication for surgery, surgical techniques and the late outcomes of surgical interventions. […] In symptomatic patients with isolated severe tricuspid valve stenosis (TS), surgery is indicated (Class I). […] In symptomatic patients with severe isolated primary TR without severe right ventricular dysfunction, surgery is indicated (Class I recommendation). […] Surgery should be considered in asymptomatic or mildly symptomatic patients with severe isolated primary TR as well as deterioration of right ventricular function or progressive right ventricular dilatation (Class IIa recommendation).

• #33 Tricuspid Valve Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/tricuspid-valve-disease/1000

  Our doctors can often repair a leaking tricuspid valve by reshaping the leaflets or stabilizing the base with a synthetic ring. In patients with tricuspid stenosis, the valve is usually replaced with a mechanical or biological tissue valve. […] The traditional approach to treating tricuspid valve disease is open-heart surgery or minimally invasive surgery (thoracotomy). But less invasive techniques are emerging. With these approaches, you spend much less time in the hospital, have less pain and recover faster. […] The Frankel Cardiovascular Center participates in several clinical trials to offer patients as many options as possible and improve outcomes. These trials use a transcatheter approach in which the doctor inserts a catheter (thin tube) into a blood vessel in the groin and guides it to the heart. Current trials use transcatheter procedures to repair and replace the tricuspid valve.

• #34 Tricuspid valve regurgitation | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20120486/

  You may need tricuspid valve repair or replacement surgery if: The valve disease is severe and you have symptoms such as shortness of breath. Your heart is growing larger or weaker, even if you don’t have symptoms of tricuspid regurgitation. You have tricuspid valve regurgitation and need heart surgery for another condition, such as mitral valve disease. […] Types of heart valve surgery to treat tricuspid regurgitation include: Tricuspid valve repair. Surgeons recommend valve repair when possible. It saves the heart valve. It also may reduce the need for long-term use of blood thinners. […] Tricuspid valve replacement. If the tricuspid valve can’t be repaired, surgery may be needed to replace the valve. […] Valve-in-valve replacement. If you have a biological tissue tricuspid valve that’s no longer working, a catheter procedure may be done instead of open-heart surgery to replace the valve.

• #35 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  For patients in whom tricuspid regurgitation is secondary to left-sided heart failure, treatment centers on adequate control of fluid overload and failure symptoms (eg, diuretic therapy). Patients should be instructed to reduce their intake of salt. Elevation of the head of the bed may improve symptoms of shortness of breath. […] Digitalis, diuretics (including potassium-sparing agents), angiotensin-converting enzyme (ACE) inhibitors, and anticoagulants are all indicated in the care of these patients. Antiarrhythmics are added as needed to control atrial fibrillation. […] The need for correction of tricuspid regurgitation is usually considered at the time of surgical correction of left-sided valve lesions. Severe regurgitation has been successfully treated with tricuspid annuloplasty. Long-term results with prosthetic rings are superior to those achieved with suture annuloplasty.

• #36 Tricuspid Regurgitation

  https://mydoctor.kaiserpermanente.org/mas/article/tricuspid-regurgitation-744501

  Procedures to repair or replace the valve may be needed in some cases. Sewing a metal, cloth, or tissue ring (annuloplasty ring) around the valve is usually the surgical treatment of choice for tricuspid regurgitation. If the valve needs to be replaced, the choice of valve to be used will be determined by you and your surgeon and will depend on your age, your willingness to take blood thinners for the rest of your life, and whether you have other heart conditions, such as a heart rhythm irregularity. There are 2 types of valves used: Mechanical metal valves last longer but require the lifelong use of blood thinners. Valves made from human, cow, or pig tissues (bioprosthetic) do not last as long as mechanical valves but do not require the use of blood thinners. Because of the higher rate of blood clots when a mechanical valve is used, a bioprosthetic valve is usually preferred for the tricuspid.

• #37 Tricuspid Regurgitation | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/tricuspid-regurgitation

  For severe tricuspid regurgitation, surgery to treat the leaky valve is necessary. Surgeons often combine tricuspid valve surgery with another procedure. For example, if the patient is having surgery to repair or replace another heart valve, the doctor may recommend repairing or replacing the tricuspid valve at the same time, even if the tricuspid regurgitation is mild or moderate. […] Surgical treatments include: Annuloplasty. This surgery tightens, remodels or reinforces the ring around the valve. […] Valve repair. Surgeons reshape or remove extra tissue so that the valve can close properly. […] Valve replacement. A mechanical valve or one made from human, cow or pig tissue is substituted for the leaky valve. […] Newer approaches use minimally invasive, catheter-based techniques to repair or replace the defective heart valve. These transcatheter heart procedures use a wire threaded through veins or arteries. They are less painful, require a shorter hospital stay and allow for a faster recovery. For patients with hearts of specific sizes and shapes, they can be a less risky option.

• #38 Tricuspid valve regurgitation: current diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8918740/

  Surgical TV repair with annuloplasty of an annulus that is 40 mm in diameter or 21 mm/m2 is the preferred treatment for functional TR. […] Patients with leaflet tethering should also undergo a leaflet procedure such as edge-to-edge repair or alternatively TV replacement. […] Transcatheter TV repair or replacement is possible in high-risk patients with an LV ejection fraction 40%, dilated tricuspid annulus and right heart chambers, and impaired RV function. […] In high-risk patients in whom TV repair is not possible, transcatheter valve insertion is emerging as a treatment option.

• #39 Tricuspid Regurgitation

  https://mydoctor.kaiserpermanente.org/mas/article/tricuspid-regurgitation-744501

  Procedures to repair or replace the valve may be needed in some cases. Sewing a metal, cloth, or tissue ring (annuloplasty ring) around the valve is usually the surgical treatment of choice for tricuspid regurgitation. If the valve needs to be replaced, the choice of valve to be used will be determined by you and your surgeon and will depend on your age, your willingness to take blood thinners for the rest of your life, and whether you have other heart conditions, such as a heart rhythm irregularity. There are 2 types of valves used: Mechanical metal valves last longer but require the lifelong use of blood thinners. Valves made from human, cow, or pig tissues (bioprosthetic) do not last as long as mechanical valves but do not require the use of blood thinners. Because of the higher rate of blood clots when a mechanical valve is used, a bioprosthetic valve is usually preferred for the tricuspid.

• #40 Tricuspid & Pulmonic Valve Repair/Replacement – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/heart-and-vascular-center/procedures/tricuspid-and-pulmonic-valve-repair-and-replacement

  Cardiac surgeons at the Brigham and Women’s Hospital (BWH) Heart Vascular Center have extensive experience performing tricuspid and pulmonic valve repair and replacement surgery. […] When your surgeon determines that your heart valve cannot be repaired, he or she may recommend valve replacement surgery. […] Damaged heart valves are replaced with a choice of substitute valves including: Mechanical valves made of durable synthetic materials such as graphite and pyrolytic carbon. These last as long as 30 years and recipients must take lifelong blood thinning medications. […] Biological valves last for 10 to 20 years and are made from animal tissue or donated human tissue. A homograft is a valve from a donated human heart. Patients do not require long-term blood thinning medications. […] Valve repair or replacement surgery corrects the problems caused by one or more diseased heart valves. You may need surgery if: You have regurgitation, You have stenosis, Your valve has developed an infection (endocarditis), You have heart symptoms, such as chest pain, shortness of breath, fainting spells or heart failure, You have edema (swelling) or weight gain due to fluid retention, Tests show that the changes in your tricuspid or pulmonic valve are affecting heart function.

• #41 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  In patients with organic disease of the tricuspid valve, corrective measures usually involve valve replacement. Because of the increased incidence of mechanical prosthetic valve thrombosis in this low-flow position, a bioprosthetic valve is preferable. […] In patients with tricuspid valve endocarditis, total excision of the tricuspid valve without immediate replacement is recommended. The diseased valvular tissue is excised to eradicate the endocarditis, and antibiotic treatment is continued. Most patients tolerate loss of the tricuspid valve well for years. If right heart failure symptoms persist despite medical management and the infections have been controlled, an artificial valve can be inserted. […] In patients with Ebstein anomaly, asymptomatic tricuspid regurgitation does not require surgery. If this anomaly produces symptomatic tricuspid regurgitation, then tricuspid valve repair or replacement is indicated.

• #42 Tricuspid Valve Disease (Types, Causes, Symptoms and Treatment)

  https://patient.info/doctor/tricuspid-valve-disease

  Medical therapy Diuretics are useful in the presence of heart failure symptoms but are of limited long-term efficacy. […] Surgery Intervention on the tricuspid valve is usually performed concomitantly during procedures for left-sided valve disease in patients who are symptomatic despite medical therapy. […] Although the lack of pliable leaflet tissue is a main limitation for valve repair, the choice between repair and replacement depends on anatomy and surgical expertise. […] Because of satisfactory long-term durability, biological prostheses are usually preferred over mechanical valves, which have a high risk of thrombosis. […] Percutaneous tricuspid balloon valvuloplasty has been performed in a limited number of cases, either alone or in combination with percutaneous mitral commissurotomy. It frequently induces significant regurgitation and long-term results are lacking. It can be considered in rare cases with anatomically suitable valves, when tricuspid stenosis is isolated or additional mitral stenosis can also be treated surgically.

• #43 Tricuspid & Pulmonic Valve Repair/Replacement – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/heart-and-vascular-center/procedures/tricuspid-and-pulmonic-valve-repair-and-replacement

  Cardiac surgeons at the Brigham and Women’s Hospital (BWH) Heart Vascular Center have extensive experience performing tricuspid and pulmonic valve repair and replacement surgery. […] When your surgeon determines that your heart valve cannot be repaired, he or she may recommend valve replacement surgery. […] Damaged heart valves are replaced with a choice of substitute valves including: Mechanical valves made of durable synthetic materials such as graphite and pyrolytic carbon. These last as long as 30 years and recipients must take lifelong blood thinning medications. […] Biological valves last for 10 to 20 years and are made from animal tissue or donated human tissue. A homograft is a valve from a donated human heart. Patients do not require long-term blood thinning medications. […] Valve repair or replacement surgery corrects the problems caused by one or more diseased heart valves. You may need surgery if: You have regurgitation, You have stenosis, Your valve has developed an infection (endocarditis), You have heart symptoms, such as chest pain, shortness of breath, fainting spells or heart failure, You have edema (swelling) or weight gain due to fluid retention, Tests show that the changes in your tricuspid or pulmonic valve are affecting heart function.

• #44 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  In patients with organic disease of the tricuspid valve, corrective measures usually involve valve replacement. Because of the increased incidence of mechanical prosthetic valve thrombosis in this low-flow position, a bioprosthetic valve is preferable. […] In patients with tricuspid valve endocarditis, total excision of the tricuspid valve without immediate replacement is recommended. The diseased valvular tissue is excised to eradicate the endocarditis, and antibiotic treatment is continued. Most patients tolerate loss of the tricuspid valve well for years. If right heart failure symptoms persist despite medical management and the infections have been controlled, an artificial valve can be inserted. […] In patients with Ebstein anomaly, asymptomatic tricuspid regurgitation does not require surgery. If this anomaly produces symptomatic tricuspid regurgitation, then tricuspid valve repair or replacement is indicated.

• #45 Transcatheter tricuspid valve intervention techniques and procedural steps for the treatment of tricuspid regurgitation: a review of the literature | Open Heart

  https://openheart.bmj.com/content/9/1/e002030

  Severe tricuspid regurgitation (TR) is an undertreated common pathology associated with significant morbidity and mortality. Classically, surgical repair or valve replacement were the only therapeutic options and are associated with up to 10% postprocedural mortality. Transcatheter tricuspid valve interventions are a novel and effective therapeutic option for the treatment of significant TR. Several devices have been developed with different mechanisms of action. They are classified as annuloplasty devices, replacement devices, caval valve implantation and coaptation devices. […] The disease currently has limited treatment options that are challenging, themselves. The management of TR includes medical, surgical and percutaneous interventional treatments. Medical therapy for the management of severe TR is often limited and mainly targets symptom relief. Furthermore, surgical replacement or repair is associated with a high rate of complications and an in-hospital mortality reaching up to 10% especially in patients with previous left-sided heart valve surgery or previous tricuspid repair.

• #46 Tricuspid Valve Treatments | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/patient-care/conditions-and-treatments/tricuspid-valve-treatments

  Often referred to as the forgotten valve, the tricuspid valve has recently been the focus of expanded research and device development. A number of new treatments are now available to tricuspid valve disease, with a number of new procedures and devices currently undergoing clinical trials. […] New minimally invasive transcatheter treatments can treat tricuspid valve disease by repairing or replacing the tricuspid valve without open surgery. […] Technological advances like robotic surgery and hybrid procedures offer treatment options to patients that would not be candidates for traditional surgery. […] Until recently, treatments for tricuspid valve disease were limited to medication and open-heart surgery. Thanks to new research and technologies, there are multiple treatment options for treating tricuspid valve disease, including new devices and minimally invasive strategies for repair and replacement.

• #47 Tricuspid Valve Treatments | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/patient-care/conditions-and-treatments/tricuspid-valve-treatments

  Transcatheter procedures are good options for patients who are too sick or frail for traditional surgery. They also offer several benefits over surgery, including shorter procedure time and hospital stays, fewer complications, faster recovery, and less pain. […] Columbia is one of the first centers in the nation to offer the EVOQUE Tricuspid Valve Replacement System, which can replace the tricuspid valve without open-heart surgery. This cutting-edge device recently became the first transcatheter therapy to be approved by the U.S. Food and Drug Administration (FDA) for treating tricuspid regurgitation (TR). […] Columbia cardiologists have worked extensively on developing and refining less invasive therapeutic options to treat tricuspid valve disease. […] Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries.

• #48 Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the “Forgotten” Valve – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-percutaneous-treatment-of-the-tricuspid–articulo-S1885585717302785

  Tricuspid valve disease is a frequent condition but is currently undertreated. A limited number of patients undergo an isolated surgical tricuspid repair, and this intervention is associated with poor outcomes, especially in patients with previous cardiac surgery. Most patients are only medically treated, despite the impact of severe tricuspid regurgitation on functional status and long-term survival. Transcatheter therapies represent a promising alternative for patients with severe tricuspid regurgitation and high surgical risk. […] In the last few years, several percutaneous alternatives have been developed for the treatment of functional tricuspid regurgitation. […] The current available transcatheter options for native tricuspid valve disease can be divided into 3 main groups: heterotopic caval valve implantation, annuloplasty devices, and coaptation devices.

• #49 Transcatheter treatment for tricuspid valve disease | EuroIntervention

  https://eurointervention.pcronline.com/article/transcatheter-treatment-for-tricuspid-valve-disease

  Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). […] The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. […] The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. […] Current transcatheter treatment options mimic surgical techniques and include approved solutions in Europe, such as leaflet approximation, direct annuloplasty and heterotopic caval valve implantation, as well as not yet commercially available transcatheter TV replacement (TTVR) systems using orthotopic valve implantation. […] Based on the aforementioned evidence, the 2021 Valvular Heart Disease guidelines of the European Society of Cardiology first give a IIb level C recommendation for transcatheter treatment of severe symptomatic TR in inoperable patients.

• #50 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Tricuspid transcatheter edge-to-edge repair (T-TEER) techniques aim to increase leaflet coaptation by grasping tricuspid valve leaflets. T-TEER devices have been developed based on the initial experience of applying mitral TEER to the tricuspid valve. The latest generation of TriClip has multiple clip sizes and allows independent leaflet grasping in order to optimise leaflet insertion. This has improved procedural results as shown in the latest data from the bRIGHT post approval study (TR reduction to moderate at 30 days in 77% of the patients). […] The TRILUMINATE Pivotal trial the first randomised control trial comparing T-TEER and medical therapy alone revealed that T-TEER with the TriClip system improved quality of life in patients with TR. On the other hand, clinical events, such as mortality or hospitalisation due to heart failure, were comparable between the T-TEER and medical therapy groups.

• #51 New Minimally Invasive Procedure Can Fix Your Heart’s Tricuspid Valve > News > Yale Medicine

  https://www.yalemedicine.org/news/new-minimally-invasive-procedure-can-fix-your-hearts-tricuspid-valve

  The interventional cardiologists began treating patients with the new clip in November 2024, using a procedure called percutaneous tricuspid transcatheter edge-to-edge repair (TEER). […] The clip is a therapy geared more toward people who are having symptoms and a more severe form of the disease, in which a substantial amount of blood leaks backward, leading to heart enlargement and failure. […] It may also be an option for those with a moderate-to-severe form of the condition who cannot tolerate the side effects of medication or who are too sick for open heart surgery. […] The TriClip G4, by Abbott, is identical to the companys MitraClip, which was introduced several years ago to correct regurgitation, or backward leaking, in the mitral valve. […] The main thing the study demonstrated for the tricuspid valve is that the procedure can reduce the amount of tricuspid regurgitation significantly, Dr. Vora says.

• #52 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Tricuspid annulus dilation reduces leaflet coaptation and represents the main mechanism of TR progression. Direct annuloplasty devices mimic surgical tricuspid annuloplasty and aim to reduce tricuspid annular size. The Cardioband system is the first device to receive a CE mark as a direct annuloplasty device for the tricuspid valve position. The implantation is performed by means of multiple screw anchors and can be cinched to improve leaflet coaptation through downsizing of the tricuspid annulus. Patients with TR primarily due to tricuspid annulus dilation may be good candidates for direct annuloplasty devices. Furthermore, the direct annuloplasty allows a combined procedure with T-TEER, which may be a promising treatment option for patients with progressive TR. Early feasibility studies in the EU and USA revealed the safety and effectiveness of TR reduction by the Cardioband system.

• #53 Tricuspid Valve Treatments | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/conditions-and-treatments/tricuspid-valve-treatments

  Transcatheter procedures are good options for patients who are too sick or frail for traditional surgery. They also offer several benefits over surgery, including: Shorter procedure time and hospital stays, Fewer complications, Faster recovery, Less pain. […] Transcatheter treatments include: Annuloplasty – A ring-shaped device is implanted to reinforce the annulus, or base, of the valve. The device can be resized during implantation to the ideal size to manage or eliminate TR. […] Columbia is one of the first centers in the nation to offer the EVOQUE Tricuspid Valve Replacement System, which can replace the tricuspid valve without open-heart surgery. This cutting-edge device recently became the first transcatheter therapy to be approved by the U.S. Food and Drug Administration (FDA) for treating tricuspid regurgitation (TR).

• #54 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Transcatheter tricuspid valve replacement (TTVR) may be a key treatment option to tackle this unmet need. Currently, the EVOQUE tricuspid valve replacement system is the first CE-certified TTVR system consisting of a self-expanding bioprosthetic valve that can be delivered percutaneously via the transfemoral transvenous approach. The prospective TRISCEND study reported feasibility, safety, and effectiveness of the EVOQUE system. The ensuing TRISCEND II Pivotal Trial, a randomised control trial comparing clinical outcomes between the EVOQUE system and conservative treatment of 150 patients, demonstrated that TTVR with the EVOQUE system improved quality of life and functional capacity at six months, compared to medical therapy alone. Notably, the EVOQUE system achieved TR reduction to mild in 93.8% of the patients.

• #55 Tricuspid Valve Treatments | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/patient-care/conditions-and-treatments/tricuspid-valve-treatments

  Transcatheter procedures are good options for patients who are too sick or frail for traditional surgery. They also offer several benefits over surgery, including shorter procedure time and hospital stays, fewer complications, faster recovery, and less pain. […] Columbia is one of the first centers in the nation to offer the EVOQUE Tricuspid Valve Replacement System, which can replace the tricuspid valve without open-heart surgery. This cutting-edge device recently became the first transcatheter therapy to be approved by the U.S. Food and Drug Administration (FDA) for treating tricuspid regurgitation (TR). […] Columbia cardiologists have worked extensively on developing and refining less invasive therapeutic options to treat tricuspid valve disease. […] Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries.

• #56 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Heterotopic tricuspid valve replacements, meaning stented valve implantation in the inferior and superior vena cava, are alternative treatment options in cases of far advanced TR with subsequent right ventricular remodelling and annular dilatation. Caval valve implantation can reduce backflow into the vena cava and may improve symptoms related to the venous congestion. The TricValve system is a CE-marked device for caval valve implantation, consisting of two self-expanding valves designed for the superior and inferior vena cava. An early feasibility study showed improvement in heart failure symptoms and quality of life after TricValve implantation. […] Transcatheter tricuspid valve repair techniques, such as T-TEER and direct annuloplasty, require life-long antiplatelet therapy after the procedures, usually with aspirin as long as there is no other indication for oral anticoagulation. For patients undergoing TTVR, life-long oral anticoagulation is recommended to prevent prosthetic valve thrombosis. However, the most appropriate regimen is not yet established. […] Multiple surgical and transcatheter treatment options are currently available for TR treatment. Data regarding safety and symptomatic improvements of transcatheter treatment are encouraging. Currently ongoing randomised control trials will show the impact of these procedures on life expectancy.

• #57 Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the “Forgotten” Valve – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-percutaneous-treatment-of-the-tricuspid–articulo-S1885585717302785

  Caval valve implantation has been performed via specifically designed devices such as the self-expandable TricValve and the balloon-expandable SAPIEN transcatheter aortic valve. […] The main disadvantage of caval valve implantation is that this therapeutic concept does not reduce TR, only its consequences. […] Tricuspid valve annuloplasty is the basis of current surgical therapy for functional TR and several percutaneous annuloplasty devices have been developed in recent years. […] These devices have the advantage of being based on a proven surgical background with good long-term outcomes. […] The Cardioband system for the treatment of the TV is a percutaneous annuloplasty ring based on the CE-approved Cardioband device for mitral regurgitation. […] The preliminary results of the TRI-REPAIR-study were recently reported in 10 patients, with a significant reduction in annulus diameter and TR regurgitation volume along with improvements in functional status at 30 days.

• #58 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  If the tricuspid valve can’t be fixed, a surgeon removes the damaged or diseased valve. The valve is most often replaced with a valve made from cow, pig or human heart tissue. A tissue valve is called a biological valve. Rarely, a mechanical valve is used. […] If you have a biological tissue tricuspid valve that’s no longer working, a doctor may use a catheter-based treatment instead of open-heart surgery to replace the valve. A catheter is a thin flexible tube. The doctor puts the tube into a blood vessel and guides it to the tricuspid valve. The replacement valve goes through the tube and into the existing biological valve. […] If tricuspid valve disease is due to a heart condition present at birth, several other treatments or surgeries may be needed. […] Talk with your healthcare team about all your treatment options. Together you can decide which treatment is best for you.

• #59 Tricuspid Regurgitation Treatment & Management: Approach Considerations, Medical Therapy, Surgical Care

  https://emedicine.medscape.com/article/158484-treatment

  In selected cases, patients who have undergone prior tricuspid valve surgery may be candidates for percutaneous tricuspid valve replacement. Indications for this procedure include significant stenosis and/or regurgitation of a bioprosthetic tricuspid valve or a right atrium-to-right ventricle (RA-to-RV) conduit.

• #60 Tricuspid Valve Treatments | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/patient-care/conditions-and-treatments/tricuspid-valve-treatments

  Transcatheter procedures are good options for patients who are too sick or frail for traditional surgery. They also offer several benefits over surgery, including shorter procedure time and hospital stays, fewer complications, faster recovery, and less pain. […] Columbia is one of the first centers in the nation to offer the EVOQUE Tricuspid Valve Replacement System, which can replace the tricuspid valve without open-heart surgery. This cutting-edge device recently became the first transcatheter therapy to be approved by the U.S. Food and Drug Administration (FDA) for treating tricuspid regurgitation (TR). […] Columbia cardiologists have worked extensively on developing and refining less invasive therapeutic options to treat tricuspid valve disease. […] Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries.

• #61 Tricuspid Valve Treatments | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/columbia-structural-heart-and-valve-center/patient-care/conditions-and-treatments/tricuspid-valve-treatments

  Hybrid surgery combines cardiac surgery with a minimally invasive transcatheter procedure. These procedures are less invasive than open heart surgery and offer many of the benefits of transcatheter treatments compared to traditional surgical approaches, including less pain, fewer complications, shorter recovery times, and reduced scarring.

• #62 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  This treatment may be done if you have tricuspid stenosis. A doctor places a thin tube with a balloon on the end into a blood vessel and guides it to the heart. Once in place, the balloon inflates. This makes the valve opening wider, improving blood flow. The catheter and balloon are removed. […] Tricuspid valve repair and tricuspid valve replacement are types of heart surgery. They can help improve blood flow and reduce symptoms. […] The type of tricuspid valve surgery needed depends on: The symptoms. How severe tricuspid valve disease is, also called the stage. Age and overall health. Whether the condition is getting worse. Whether surgery is needed to correct another valve or heart condition. […] Surgeons do tricuspid valve repair when possible. Repair saves the heart valve and improves how the heart works. Tricuspid valve repair is usually done with open-heart surgery. Sometimes, a tricuspid valve can be repaired with minimally invasive heart surgery or a procedure using thin tubes called catheters and a clip.

• #63 Tricuspid valve interventions: surgical techniques and outcomes | EuroIntervention

  https://eurointervention.pcronline.com/article/tricuspid-valve-interventions-surgical-techniques-and-outcomes

  After left-sided valve surgery, isolated tricuspid valve surgery should be considered in patients with severe TR, who are either symptomatic or who show progressive right ventricular dilatation/dysfunction, in the absence of left-sided valve dysfunction, severe right or left ventricular dysfunction, or severe pulmonary vascular disease. […] Concomitant to left-sided valve surgery tricuspid valve surgery is indicated in the case of patients with severe primary or secondary TR (Class I recommendation). […] If valve repair is impossible or if the result of a repair attempt is not satisfactory, tricuspid valve replacement needs to be carried out. […] Currently, the use of large-sized bioprostheses is favoured over valve replacement with mechanical valves. […] Surgical treatment of FTR has mainly been focused on correction of annular dilatation over many years.

• #64 Transcatheter treatment for tricuspid valve disease | EuroIntervention

  https://eurointervention.pcronline.com/article/transcatheter-treatment-for-tricuspid-valve-disease

  Tricuspid transcatheter edge-to-edge repair (T-TEER) using the TriClip (Abbott Vascular, Santa Clara, CA, USA) or leaflet approximation with the PASCAL systems (Edwards Lifesciences, Irvine, CA, USA) are approved in Europe for minimally invasive TV repair. […] The Cardioband direct annuloplasty system (Edwards Life-sciences) obtained CE mark for the treatment of patients with severe symptomatic STR in 2018. […] TTVR was first performed in 2017 using the GATE bioprosthesis (NaviGate Cardiac Structures, Inc., Lake Forest, CA, USA) that was introduced mainly via the transatrial surgical route using a 42 Fr catheter delivering an up to 54 mm stented valve. […] Heterotopic caval valve implantation can mitigate symptoms related to TR and associated RV failure without treating its cause and is therefore a useful symptomatic treatment option in patients who are unsuitable for other transcatheter or surgical procedures. […] A multidisciplinary Heart Team approach is recommended for the evaluation of patients with TV disease in a Heart Valve Centre with expertise in a broad spectrum of diagnostic and therapeutic solutions.

• #65 Review and Treatment Options for the Tricuspid Valve: Key Points

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/04/29/15/31/the-tricuspid-valve-a-review

  It is important to consider the lifetime management of patients with TV disease. When young patients present with severe tricuspid regurgitation, they will need a durable device and ideally the potential option of a second transcatheter device in the future should the first device deteriorate over time. […] For elderly, frail patients, alleviating symptoms and improving their present quality of life may be the primary goal; therefore, long-term lifetime management may not be as applicable. As clinical studies continue, a greater understanding of device durability will allow clinicians to better advise patients about the long-term management of TV disease.

• #66 Tricuspid Valve Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/tricuspid-valve-disease/1000

  Because tricuspid valve disease frequently occurs along with other heart or valve conditions, doctors often combine treatments. For example, doctors may perform procedures to treat coronary artery disease, atrial fibrillation and cardiomyopathy along with tricuspid valve repair or replacement. […] To avoid a second surgery, our doctors may proactively repair a tricuspid valve while repairing a mitral valve.

• #67 Tricuspid Valve Disease | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/tricuspid-valve-disease

  Because tricuspid valve disease frequently occurs along with other heart or valve conditions, doctors often combine treatments. For example, doctors may perform procedures to treat coronary artery disease, atrial fibrillation and cardiomyopathy along with tricuspid valve repair or replacement. […] To avoid a second surgery, our doctors may proactively repair a tricuspid valve while repairing a mitral valve.

• #68 Tricuspid Valve Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/tricuspid-valve-disease/1000

  Because tricuspid valve disease frequently occurs along with other heart or valve conditions, doctors often combine treatments. For example, doctors may perform procedures to treat coronary artery disease, atrial fibrillation and cardiomyopathy along with tricuspid valve repair or replacement. […] To avoid a second surgery, our doctors may proactively repair a tricuspid valve while repairing a mitral valve.

• #69 Tricuspid Valve Disease (Types, Causes, Symptoms and Treatment)

  https://patient.info/doctor/tricuspid-valve-disease

  For adults, the National Institute for Health and Care Excellence (NICE) recommends: Consider surgical tricuspid valve repair at the time of mitral valve surgery when tricuspid regurgitation is moderate or severe. […] Consider surgical tricuspid valve repair at the time of aortic valve surgery when tricuspid regurgitation is severe.

• #70 Tricuspid valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-disease/diagnosis-treatment/drc-20573710

  Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is. […] Treatment may include: Regular health checkups. Medicines. Surgery to fix or replace the valve. […] If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working. […] Medicine may be used to treat: The underlying cause of tricuspid valve disease. Complications such as heart failure. […] For example, diuretics, also called water pills, may be given to help remove fluid from the body. […] If a current infection causes tricuspid valve disease, antibiotics are usually given. […] If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms. […] If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

• #71 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Heterotopic tricuspid valve replacements, meaning stented valve implantation in the inferior and superior vena cava, are alternative treatment options in cases of far advanced TR with subsequent right ventricular remodelling and annular dilatation. Caval valve implantation can reduce backflow into the vena cava and may improve symptoms related to the venous congestion. The TricValve system is a CE-marked device for caval valve implantation, consisting of two self-expanding valves designed for the superior and inferior vena cava. An early feasibility study showed improvement in heart failure symptoms and quality of life after TricValve implantation. […] Transcatheter tricuspid valve repair techniques, such as T-TEER and direct annuloplasty, require life-long antiplatelet therapy after the procedures, usually with aspirin as long as there is no other indication for oral anticoagulation. For patients undergoing TTVR, life-long oral anticoagulation is recommended to prevent prosthetic valve thrombosis. However, the most appropriate regimen is not yet established. […] Multiple surgical and transcatheter treatment options are currently available for TR treatment. Data regarding safety and symptomatic improvements of transcatheter treatment are encouraging. Currently ongoing randomised control trials will show the impact of these procedures on life expectancy.

• #72 The Diagnosis and Treatment of Tricuspid Regurgitation (23.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240811

  Background: It is estimated that 6% of persons over age 75 have clinically relevant tricuspid regurgitation (TR). This condition carries a high mortality and is of particular interest because of the recent development of new interventional treatments. […] The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). Early referral to a specialized heart valve center is essential for the prevention of irreversible damage of the right heart and secondary end-organ damage, including cardiohepatic and cardiorenal syndromes. […] The first randomized controlled trial of treatment for TR yielded a win ratio of 1.48 (95% confidence interval, [1.06; 2.13]) for interventional treatment (edge-to-edge repair) compared to optimal medical therapy. […] As the understanding of tricuspid regurgitation improves, strategies for its interventional treatment are undergoing steady development, with the aim of lowering the mortality of this condition.

• #73 Tricuspid regurgitation – Part 2: treatment options

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tricuspid-regurgitation-part-2-treatment-options

  Transcatheter tricuspid valve replacement (TTVR) may be a key treatment option to tackle this unmet need. Currently, the EVOQUE tricuspid valve replacement system is the first CE-certified TTVR system consisting of a self-expanding bioprosthetic valve that can be delivered percutaneously via the transfemoral transvenous approach. The prospective TRISCEND study reported feasibility, safety, and effectiveness of the EVOQUE system. The ensuing TRISCEND II Pivotal Trial, a randomised control trial comparing clinical outcomes between the EVOQUE system and conservative treatment of 150 patients, demonstrated that TTVR with the EVOQUE system improved quality of life and functional capacity at six months, compared to medical therapy alone. Notably, the EVOQUE system achieved TR reduction to mild in 93.8% of the patients.

• #74 Transcatheter Treatments of the Tricuspid Valve: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/03/25/15/05/transcatheter-treatments-of

  For secondary TR, treatment options are more nuanced depending on atrial- or ventricular-based TR. For ventricular-based secondary TR, understanding RV function and RV/pulmonary artery coupling will determine the utility of therapy. For atrial-based secondary TR, in addition to therapy for atrial fibrillation, the decision regarding T-TEER, transcatheter tricuspid annuloplasty, TTVR, or CAVI is based on annulus size, coaptation gap, and depth. […] […] Future directions include identifying novel diagnostic and patient selection tools, identifying new imaging techniques to improve procedural training and outcomes, and continuing to improve on current devices and technology. Given the complexity of right heart disease and TR, a one-size-fits-all approach is unlikely to succeed. Collaboration between cardiology specialties and a patient-centered approach will be needed to improve outcomes.

• #75 Tricuspid Regurgitation Therapy | ECR Journal

  https://www.ecrjournal.com/articles/tricuspid-regurgitation-disease-state-and-advances-percutaneous-therapy?language_content_entity=en

  Tricuspid regurgitation (TR) is a relatively common finding. […] However, symptomatic TR remains undertreated despite emerging therapeutic modalities. In this review, the pathophysiological and epidemiological features of TR are examined and the diagnosis, natural history, and clinical presentation are discussed. An overview of TR therapy is provided, including medical and surgical treatments, as well as novel percutaneous approaches. The currently available studies on percutaneous therapy demonstrate promise for transcatheter valve repair and replacement with favourable clinical outcomes and short-term durability. However, further study is needed. […] Management of moderate to severe TR may include TV repair or replacement (surgical or transcatheter approach). For patients undergoing left-sided valve surgery with severe TR, concomitant TV surgery is a class 1 recommendation in the current ACC/AHA guidelines.

• #76 Tricuspid valve disease: diagnosis, prognosis and management of a rapidly evolving field – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30988448/

  Tricuspid valve disease, and particularly tricuspid regurgitation, is a highly prevalent condition with a complex pathophysiology and long-term adverse consequences. […] Surgical treatment remains the standard of care, but it continues to have one of the the highest death rates among all cardiac valve-related procedures, and a broad range of patients still do not receive effective therapy for tricuspid valve disease in contemporary clinical practice. […] Therefore, several alternative, less-invasive technologies for treating patients with severe, native tricuspid valve disease at high surgical risk have been developed in the past decade, with promising early results.

• #77 The Diagnosis and Treatment of Tricuspid Regurgitation (23.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240811

  Another interventional treatment option is heterotopic valve replacement, in which one or more valvular prostheses are implanted into the superior and inferior vena cava. […] To prevent irreversible damage to the right heart and the development of secondary organ complications, early outpatient diagnosis with timely referral to an experienced heart valve center is crucial.

• #78 Transcatheter tricuspid valve intervention techniques and procedural steps for the treatment of tricuspid regurgitation: a review of the literature | Open Heart

  https://openheart.bmj.com/content/9/1/e002030

  TR is a highly prevalent disease that is associated with high mortality and morbidity when left untreated. Historically, surgical repair or replacement were the only therapeutic options; however, due to their high complication rate they were often deferred. TTVIs that have been showed to be feasible, associated with low mortality rates, and effective in reducing TR associated with alleviation of symptoms.

• #79 Tricuspid Regurgitation Therapy | ECR Journal

  https://www.ecrjournal.com/articles/tricuspid-regurgitation-disease-state-and-advances-percutaneous-therapy?language_content_entity=en

  More recently, the advent of percutaneous options for TR treatment has broadened the treatment possibilities. […] The relative benefit from surgery versus medical therapy remains unclear, and the optimal approach to TR treatment remains debatable, given the scarcity of evidence available concerning long-term outcomes. […] Emerging percutaneous therapeutic modalities for tricuspid regurgitation show promise with favourable clinical outcomes and durable short-term results. However, more study is needed.

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