Multimodality imaging for transcatheter tricuspid valve repair and replacement

Abstract

Transcatheter tricuspid intervention is a rapidly evolving field with multiple classes of therapeutic devices currently in development. Procedural success in tricuspid intervention is predicated on appropriate device selection for patient specific anatomy and satisfactory imaging for intra-procedural guidance. This review will outline protocols and methodology for multi-modality imaging assessment of the tricuspid valve and associated structures, with emphasis on anatomic and functional characteristics that determine suitability for each class of tricuspid intervention. Intra-procedural imaging requirements for each class of device, with design and procedural imaging guidance of specific devices, will also be addressed.

Step-by-step transesophageal echocardiographic guidance for transjugular transcatheter tricuspid valve replacement with a radial force-independent bioprosthesis

“…All current transcatheter TV replacement systems with published human results are not repositionable. Next-generation devices with recapturable design including the Trisol and the Intrepid system (NCT04433065) may improve the possibility of successful implantation ( 18 ).…”

“…The maximal and mean transvalvular pressure gradient should also be assessed, though elevated pressure gradient is rare ( 18 ). If the prosthetic valve is coaxial, the paravalvular leak is moderate or less, the mean transvalvular pressure gradient is less than 2 mmHg, and no other complications such as pericardial effusion are found, the valve and delivery system can be dissociated and the delivery system can be withdrawn.…”

Transcatheter Therapy for the Tricuspid Valve: A Focused Review of Edge-to-Edge Repair and Orthotopic Valve Replacement

“…T-TEER and TTVR are the most extensively evaluated transcatheter treatments for TR to date. As the field continues to progress, treatment algorithms specific to certain anatomic and physiologic subsets will likely continue to emerge [10,27,63,64]. The recent TRILUMINATE and TRISCEND II pivotal RCTs results prove that T-TEER and TTVR can reduce TR and associated symptoms and highlight some of the strengths and limitations of these two therapies.…”

“…During further expansion, anchor tips are positioned below the annulus ensuring leaflets are captured. At each stage of the procedure, all nine anchors must be individually imaged for correct positioning [ 27 ]. After optimal anchor positioning and confirmed leaflet capture, the EVOQUE valve is fully deployed and released from the delivery system.…”