Transcatheter tricuspid valve interventions (TTVI) are minimally invasive options for treating severe tricuspid valve regurgitation. Tricuspid regurgitation occurs when the valve between the heart's two right chambers doesn't close properly, allowing some blood to flow backward into the heart. As a result, the heart has to work harder than it should to pump blood to the lungs and the rest of the body. That can cause shortness of breath and swelling of the legs and feet or swelling of the abdomen – symptoms that can worsen over time.

Transcatheter tricuspid valve replacement (TTVR), using the Evoque system made by Edwards Lifesciences, is a way to replace a stretched-out or diseased tricuspid valve without open-heart surgery. An alternative strategy is to improve the function of the damaged tricuspid valve through a procedure called tricuspid transcatheter edge-to-edge repair (T-TEER), which uses the TriClip device made by Abbott.

The Evoque system allows doctors to replace the damaged valve with an artificial one made of cow tissue and attached to a flexible metal frame, which lets the device expand and fit securely within the heart. The frame is implanted using a catheter (a thin, flexible tube) that doctors introduce through a vein in the groin and guide through the vessel until they reach the heart. The only incision required is a small one in the groin for inserting the catheter. Similarly, doctors insert the TriClip system through a vein in the leg; it's used to bring the diseased valve's flaps together so that it can form a better seal when it closes.

TTVI can help your heart function better; relieve shortness of breath, swelling and other symptoms; and improve your quality of life.

Evaluation

To assess the condition of your tricuspid valve and determine whether you are a candidate for TTVR or T-TEER, your doctor may order one or more of the following tests:

  • Echocardiogram. This is an ultrasound of the heart, a painless way to assess its structure and diagnose valve problems. The ultrasound can be done from the outside of the body, through the chest (transthoracic), or from inside the esophagus (transesophageal), using an endoscope to get clearer images of the back of the heart.
  • Electrocardiogram (ECG). This painless test measures the heart's electrical activity. It can detect enlarged heart chambers, heart disease and abnormal heart rhythms.
  • Cardiac computed tomography (CT) scan. This imaging technique uses X-rays to create detailed pictures of the heart and surrounding blood vessels.
  • Right heart catheterization. Also called Swan-Ganz catheterization, this test is used to assess the heart's function as well as the blood flow and pressure in and around the heart. To perform the test, a catheter is threaded into the right side of the heart and the arteries leading to the lungs.

When your evaluation is complete, our team of specialists meets to discuss the results and determine whether TTVI is an appropriate option for you. The team includes general cardiologists, interventional cardiologists, heart surgeons and imaging experts.

Procedure

TTVR and T-TEER are performed in the cardiac catheterization lab rather than a standard operating room. Either procedure takes approximately two hours, and patients are under general anesthesia (completely asleep).

To begin, the cardiologist makes a small incision in the groin area to access the femoral vein and – guided by X-ray and ultrasound imaging – threads a catheter through this blood vessel up to and into the heart. The catheter conveys the valve replacement or repair device. Once this system is positioned inside the diseased valve, the doctor releases it from the catheter.

A replacement valve functions the same way the old valve did when healthy – opening and closing to allow blood to flow in the correct direction within the heart. The valve repair system keeps your valve in place but allows it to close more normally, reducing backflow.

Recovery

Immediately following the procedure, patients are monitored in either the post-anesthesia or intensive care unit, depending on the level of care needed. Patients are generally encouraged to be up and walking within 24 hours, and most are able to do so. The hospital stay is typically about one to four days.

During your post-op stay, your care team will conduct follow-up tests to ensure the new or newly repaired valve is functioning properly. These may include chest X-rays, blood tests, an echocardiogram and an ECG.

Before you're discharged, your heart team will talk with you about home care, providing instructions on diet, exercise, care of your incision site, and use of current or new medications. Most people have fully returned to normal activities three to four months after surgery.

Follow-up

After transcatheter tricuspid valve replacement, regular checkups with your primary care provider and local cardiologist are essential. Your doctor will likely want to see you one month after the procedure and then annually for up to five years. These visits are important for ensuring the device is functioning properly and detecting any problems early. However, any time you have questions or concerns about your heart or general health, you should see your doctor promptly – don't wait for a scheduled checkup.

Following either TTVR or T-TEER, your doctor may recommend a cardiac rehabilitation program. In cardiac rehab, a team of health care professionals provides education and support to enhance your recovery and prevent future heart problems.