Materiały źródłowe

• #1 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. […] The exact treatment depends on your symptoms and how severe the valve disease is. Some people with mild tricuspid valve regurgitation only need regular health checkups. Your healthcare team tells you how often you need appointments. […] 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.

• #2 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.

• #3 Treatment options for severe functional tricuspid regurgitation: indications, techniques and current challenges

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Treatment-options-for-severe-functional-tricuspid-regurgitation-indications-techniques-and-current-challenges

  Severe functional tricuspid regurgitation represents an important unmet need in clinical cardiology given its prevalence, adverse prognostic impact and symptom burden. Surgical tricuspid valve annuloplasty remains the treatment of choice for the majority of patients, especially if the operative risk is acceptable and preserved right ventricular function is present. […] However, several transcatheter techniques are currently in bench and early clinical testing to provide alternative treatment options for patients with a very high surgical risk. Future trials are needed to address the question as to whether transcatheter treatment of tricuspid regurgitation improves long-term prognosis and is superior to medical treatment alone in these patients. […] Frequently, patients with moderate-to-severe TR present late in the natural history of the disease with exercise limitation and other symptoms of right heart failure difficult to treat by medical therapy. […] Nevertheless, in a considerable number of patients medical treatment options of TR are limited for the following reasons: often, an impairment of kidney function in patients with advanced TR limits further escalations of diuretic dose to improve symptoms of volume overload.

• #4 Tricuspid regurgitation – Part 2: treatment options

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

  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.

• #5 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.

• #6 Tricuspid Regurgitation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526121/

  Treatment preference depends on the severity of tricuspid regurgitation, etiology, and the presence and extent of associated abnormalities, including pulmonary hypertension, heart failure, and other valve conditions. […] Management of severe tricuspid regurgitation includes medical therapy, counseling regarding pregnancy and physical activity, consideration of tricuspid valve surgery, and evaluation and treatment of the underlying cause. […] Control fluid overload adequately for patients with tricuspid regurgitation secondary to left-sided heart failure. Diuretics, particularly loop diuretics, are commonly recommended. […] The necessity for tricuspid valve surgery hinges on whether surgery for left-sided (aortic or mitral) valve disease is warranted. […] Tricuspid valve surgery is recommended in patients with severe tricuspid regurgitation, as observed in the 2014 American Heart Association/American College of Cardiology (AHA/ACC) and the 2012 European Society of Cardiology (ESC) valvular disease guidelines.

• #7 Tricuspid Regurgitation – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/tricuspid-regurgitation

  Selected symptomatic patients require annuloplasty or valve repair or replacement. […] Sometimes annuloplasty or valve repair or replacement. […] Medical treatment of causes (eg, heart failure, endocarditis) is indicated. […] Medical therapy with loop diuretics can relieve congestion. Aldosterone antagonists may be of additive benefit as they counter secondary hyperaldosteronism due to hepatic congestion. […] Timing of intervention for tricuspid regurgitation depends on the patient’s symptoms and RV function. Patients with severe tricuspid regurgitation should undergo operation as soon as symptoms are present despite medical treatment or when there is moderate, progressive RV enlargement or dysfunction. […] Surgical options include annuloplasty, valve repair, and valve replacement.

• #8 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.

• #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

  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. […] Inpatient care of patients with tricuspid regurgitation requires control of the following: Heart failure, Treatment of any infectious process that may have affected the valve, Control of arrhythmias that may be present. […] Anticoagulation is generally in order if atrial fibrillation is present or valve replacement has been undertaken. The international normalized ratio (INR) should be maintained between 3-4 following valve replacement, because of the associated low flow state.

• #11 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 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. The vast majority of patients who undergo tricuspid valve interventions suffer from concomitant atrial fibrillation, and, therefore, oral anticoagulation can be continued without the need for adaptation of the treatment regimen. For patients undergoing TTVR, life-long oral anticoagulation is recommended to prevent prosthetic valve thrombosis. However, the most appropriate regimen is not yet established. […] Tricuspid regurgitation is a common valvular disease leading to a significant reduction of functional capacity and is associated with excess morbidity and mortality if left untreated. 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.

• #12 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. […] Medical therapy remains the primary approach for the management of symptomatic TR in most patients. The use of diuretics is the mainstay of therapy for TR and is a class 2a recommendation in the current ACC/AHA guidelines.

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

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

  The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). […] 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. […] The currently prevailing guidelines recommend tricuspid valve surgery, with simultaneous operative treatment of the left heart in the presence of severe TR or dilatation of the tricuspid annulus in patients with low surgical risk. […] Numerous interventional treatment procedures have been developed on the basis of surgical techniques in recent years.

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

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

  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. 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.

• #15 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.

• #16 Treatment options for severe functional tricuspid regurgitation: indications, techniques and current challenges

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Treatment-options-for-severe-functional-tricuspid-regurgitation-indications-techniques-and-current-challenges

  Current guidelines for the management of valvular heart disease provide recommendations to guide surgical interventions in primary and secondary TR. […] The optimal timing of surgical intervention for TR remains controversial. However, delayed surgery must be avoided given the risk of irreversible right ventricular damage, organ failure and poor results of later surgical intervention. […] Surgical tricuspid valve repair with annuloplasty is the preferred treatment for functional TR in patients with suitable anatomy, preserved right ventricular function and acceptable surgical risk. […] Tricuspid valve repair is associated with lower perioperative mortality as compared to valve replacement in patients with functional TR and, therefore, is generally the preferred surgical treatment option.

• #17 Surgical Treatment Strategy of Functional Tricuspid Regurgitation

  https://www.imrpress.com/journal/RCM/25/5/10.31083/j.rcm2505182/htm

  The 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Management of Patients with Valvular Heart Disease provide a Class of Recommendation 1 Level for patients with severe TR (Stages C and D) undergoing left-sided valve surgery and recommend tricuspid valve surgery. […] At one time there was considerable controversy over whether tricuspid valves should be replaced or repaired, and it was found that tricuspid valve repair provided a better prognosis. […] The choice of mechanical or biologic valves is a topic that is never more relevant in valve replacement. […] In conclusion, when considering tricuspid valve replacement, it is necessary to take into account the patient’s age, willingness to use anticoagulants, clinical status, type of disease, and social factors to develop a personalized and specialized treatment plan for the patient. […] Surgery is an effective treatment for FTR and can effectively improve the degree of TR and prognosis of TR patients.

• #18 Management of Tricuspid Regurgitation: The Role of Transcatheter Therapies | ICR Journal

  https://www.icrjournal.com/articles/management-tricuspid-regurgitation-role-transcatheter-therapies?language_content_entity=en

  Surgical treatment is the gold standard treatment of functional tricuspid regurgitation (FTR) but this carries high risks of morbidity and mortality. […] Percutaneous procedures are an attractive alternative to surgery for selected patients deemed to be high-risk surgical candidates. […] A number of tricuspid transcatheter devices have been developed to treat FTR, but at present, evidence of their efficacy and safety is scarce. […] Preliminary data have shown promising results, but ongoing and future studies will provide a clearer picture of the benefits of these new techniques. […] Patients who could benefit from transcatheter treatment of TR are those with symptomatic TR irrespective of maximal medical therapy or with initial signs of RV dysfunction, who are deemed to be either at high risk for conventional open heart surgery or inoperable.

• #19 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 you have severe tricuspid valve disease, surgery may be done to fix or replace the valve. […] Tricuspid valve repair and tricuspid valve replacement are types of heart surgery. They can help improve blood flow and reduce symptoms. […] 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. […] 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. […] 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. […] Talk with your healthcare team about all your treatment options. Together you can decide which treatment is best for you.

• #20 Tricuspid Valve Regurgitation | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/triscuspid-valve-regurgitation

  Heart specialists at Mass General Brigham are experts at advanced tricuspid and pulmonary valve repair and replacement procedures. When possible, our team performs these procedures through catheter-based therapies instead of open-heart surgery. Minimally invasive cardiac surgery often means less blood loss, scarring, and infection risk. You benefit from a faster, less painful recovery. […] Medications can treat underlying causes of tricuspid valve disease, as well as ease symptoms. […] Valve repair procedures depend on disease type, cause, and severity. Treatments include: Commissurotomy, a surgical procedure to cut and separate fused, stiffened valve leaflets that cause stenosis; Ring annuloplasty, a surgical procedure to tighten the natural valve ring and stop regurgitation by placing a lab-made ring around it; Valvuloplasty, using a balloon device threaded through a catheter to separate leaflets and expand a narrowed tricuspid valve opening; Transcatheter edge-to-edge repair (TEER), a catheter-based procedure to clip the leaflets of the tricuspid valve together to minimize leakage.

• #21 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.

• #22 Tricuspid Regurgitation

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

  Over time, we will keep an eye on your symptoms and the results of certain tests, to decide when to recommend valve repair or replacement. […] Surgery will typically be recommended if you begin to have heart symptoms. […] 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.

• #23 Treatment options for severe functional tricuspid regurgitation: indications, techniques and current challenges

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Treatment-options-for-severe-functional-tricuspid-regurgitation-indications-techniques-and-current-challenges

  In recent years, several devices have entered preclinical and early clinical testing for transcatheter treatment of functional TR. […] Current studies aim to address the question whether interventional TR treatment provides an alternative therapeutic option for patients with severe functional TR, intractable symptoms of right heart failure and prohibitive surgical risk based on the conclusive decision of a multidisciplinary Heart Team. […] A retrospective analysis of patients with isolated TR suggests that severe TR is a serious disease characterised over time by a cumulative high rate of complications. […] In these patients, surgical repair of the tricuspid valve was feasible, with low operative mortality and marked symptomatic improvement in 88% of patients, indicating that surgical is superior to medical treatment in patients with isolated severe TR.

• #24 Tricuspid regurgitation – Part 2: treatment options

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

  Transcatheter TV interventions have emerged as a promising alternative for patients with isolated TR who are at high surgical risk. Early experience of transcatheter techniques in Europe have demonstrated the safety and feasibility of reducing TR, with improvements in heart failure symptoms and quality of life. Furthermore, a propensity score-matching analysis has shown the potential benefit of transcatheter tricuspid valve intervention on long-term survival compared to medical therapy. The European Society of Cardiology (ESC) guidelines recommend transcatheter treatments in symptomatic patients with isolated secondary TR who are considered inoperable by the Heart Team discussion. Currently, multiple transcatheter devices are commercially available in the EU, and several are under investigation. Proper device selection is key to a successful intervention and postinterventional results.

• #25 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 (TriClip G4 system; Abbott) 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). […] Similarly, the PASCAL system (Edwards Lifesciences) has shown encouraging results in early feasibility studies in the EU and USA. The PASCAL system consists of a central spacer that acts as a filler in the regurgitant orifice of the TV, while its nitinol construction may minimise the stress on fragile tricuspid leaflets.

• #26 Tricuspid regurgitation – Part 2: treatment options

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

  Owing to its broad availability and high safety, T-TEER is the most widely used transcatheter technique for TR in the current clinical environment. 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. Several other ongoing randomised control trials, including the CLASP II TR trial (the PASCAL system vs medical therapy), will provide further insights into the benefits of T-TEER during the year 2024. […] 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 (Edwards Lifesciences) is the first device to receive a CE (European conformity) 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.

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

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

  The most widely performed procedure is CE-certified edge-to-edge repair using the TriClip system (Abbott Vascular) or the PASCAL system (Edwards Lifesciences). […] A randomized controlled trial (TRILUMINATE Pivotal) confirmed the safety of the procedure and demonstrated for the first time the superiority of tricuspid interventions over medical treatment. […] If edge-to-edge repair is technically infeasible, alternative forms of treatment are evaluated. […] 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.

• #28 Tricuspid regurgitation – Part 2: treatment options

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

  Despite the multiple options of repair devices, there remain concerns about significant residual TR in a non-negligible number of patients. Transcatheter tricuspid valve replacement (TTVR) may be a key treatment option to tackle this unmet need. Currently, the EVOQUE tricuspid valve replacement system (Edwards Lifesciences) 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. This ability to eliminate TR is one of the major advantages, which may lead to better clinical outcomes.

• #29 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

  While T-TEER is the most performed intervention, annuloplasty replicates the most common surgical repair procedure, with the advantage of leaving all alternative options open. Cardioband was the first TTVI device implanted in Europe. Despite its strong rationale, however, it is implanted only in very experienced centers because of the complexity of the procedure and the potential risk of coronary lesions. […] […] Transcatheter tricuspid valve replacement (TTVR) has been performed off-label as valve-in-valve and valve-in-ring procedures. There are several dedicated tricuspid replacement devices under clinical investigation currently. […] […] The decision regarding choice of transcatheter therapy for primary TR is predicated on several factors including leaflet anatomy, annular dimensions, and mechanism of regurgitation. Leaflet prolapse, flail or papillary muscle rupture can be considered for T-TEER. […]

• #30 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 treatments include: Annuloplasty – A ring-shaped device is implanted to reinforce the annulus, or base, of the valve. […] 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. […] The tricuspid valve can also be repaired or replaced using traditional open surgery with general anesthesia. […] Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries. […] 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.

• #31 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 (bicaval valve implantation), 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 (European conformity)-marked device for caval valve implantation, consisting of two self-expanding valves designed for the superior and inferior vena cava. An early feasibility study (the TRICUS EURO) showed improvement in heart failure symptoms and quality of life after TricValve implantation. However, heterotopic tricuspid valve replacement remains a bailout option for patients with anatomy ineligible for other transcatheter devices or inadequate echocardiographic imaging quality.

• #32 Tricuspid Valve Treatments | Division of Cardiology

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

  Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries. […] 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, Reduced scarring.

• #33 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

  Patients with severe symptomatic isolated TR should undergo disease staging using imaging, clinical status, and biomarkers. For low-risk patients, surgery should be considered. TRI-SCORE is a scoring method used to predict hospital mortality in patients undergoing surgery for isolated TR. For high-risk patients with advanced disease, palliation should be recommended. For high-risk patients with a favorable prognosis, TTVI should be considered. Decision regarding type of TTVI is predicated on multi-modality imaging (TTE, TEE, CT, cardiac magnetic resonance [CMR]) and right heart catheterization. […] […] TTVI can be achieved with leaflet approximation devices (tricuspid transcatheter edge-to-edge repair (T-TEER) with annuloplasty, or with other devices including spacers (devices filling the coaptation gap) and chordal approximation devices. T-TEER remains the most commonly performed repair procedure. T-TEER addresses TR by a combination of leaflet approximation at the site of regurgitation and indirect annular reduction. […]

• #34 Contemporary Treatment of Tricuspid Regurgitation – Cardiac Interventions Today

  https://citoday.com/articles/2022-sept-oct/contemporary-treatment-of-tricuspid-regurgitation

  Putting all these considerations together, and according to current guidelines, surgery is recommended in symptomatic patients with severe TR and without severe right ventricular dysfunction. […] In patients with higher surgical risk (which is not uncommon in TR patients) or who are considered inoperable, percutaneous transcatheter therapies are considered in the European guidelines (class IIb indication). […] Selecting the best technique for surgery and percutaneous intervention will depend on the valve anatomy, with repair options preferred. […] For functional TR, the stage of disease will also determine the repairability and the technique/device of choice. […] Surgical TV repair (mainly annuloplasty if there is adequate TV anatomy) is preferred over replacement in symptomatic patients with severe TR and acceptable surgical risk.

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

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

  Transcatheter tricuspid valve intervention (TTVI) is under clinical development. TTVI may be considered at experienced Heart Valve Centres in symptomatic, inoperable, anatomically eligible patients in whom symptomatic or prognostic improvement can be expected. […] 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.

• #36 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.

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

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

  Patients with a history of tricuspid regurgitation should be carefully monitored for control of any heart failure. Repeat echocardiography is indicated at 6-month intervals for patients in whom the valve has been removed. Annual echocardiography should be considered in patients whose valve has been replaced.

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