乌鸦传媒

Current surgical efforts to rein in tricuspid regurgitation still leave many patients undertreated, so researchers are looking to catheter-based technologies to solve this problem.

In this exclusive 乌鸦传媒 video, , Medical Director of the Center for Structural Heart Disease at Henry Ford Hospital in Detroit, discusses how structural interventionalists are hoping to treat the tricuspid valve, and predicts what will (and won't) make it 5 years from now.

A transcript of his remarks follows:

Currently, tricuspid regurgitation is one of the last frontiers for structural intervention. The tricuspid valve [is] very difficult to treat, very undertreated right now. In the United States, less than 1% of people with severe tricuspid regurgitation are having surgical repair, and so we're looking for catheter-based techniques.

There [are] two broad categories: one is putting in a new valve, and the second is fixing the tricuspid annulus. If we take a look at where we are, there are two or three devices that are currently being used. The Edwards valve has kind of a bob that sits inside the tricuspid valve and closes over to help decrease tricuspid regurgitation. That device is being tested in the United States right now. Early data suggest that it might be useful, but I'm not totally convinced that that's going to be main therapy. I don't think that replacing the valve with a new tricuspid valve is really going to be the way to go, because the annulus is too large. Putting in a valve leaflet into the small right ventricle is only going to be very difficult and there is going to be a high risk of valve thrombosis.

Another valvular approach is putting a caval valve at the caval IVC [inferior vena cava] junction. There is currently a U.S. trial called that's going on and they are recruiting patients for that trial. Then finally, annular devices are probably going to be our best approach, and there are methods being tried to shrink the annulus so the tricuspid leaflet, to try to close the valve better.

The main advantage that percutaneous techniques have over surgery is people that have severe tricuspid regurgitation end up with very severe ascites. It's peripheral edema and liver congestion. The liver starts failing and the patients are very ill. They are very bed-ridden, very difficult to ambulate, and very high-risk for surgeries. These are the kinds of patients that we are treating right now.

I think 5 years from now where we're going to be is going to be having probably at least one annular solution to shrink the annulus in combination with perhaps repair of the leaflets. Abbott is looking at taking the MitraClip device and putting into the tricuspid valve, modifying it so that it can actually clip the leaflet. So, I think that combination is probably going to be ideal, shrinking the annulus and clipping the valve, and I think that probably 5 years from now that's where the field is going to be.

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