Tricuspid Valve Treatments

Reviewed by Columbia Structural Heart and Valve Center Faculty, July 2024

At a Glance

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.

What is the Tricuspid Valve?

The tricuspid valve helps manage blood flow from the heart’s right atrium into the right ventricle.

What is Tricuspid Valve Disease?

Tricuspid valve disease keeps the valve from functioning properly and has two main forms:

Tricuspid Regurgitation (TR) or Tricuspid Insufficiency: When the tricuspid valve cannot fully close, blood flows backward into the right atrium. This reversed flow creates pressure that can cause structural damage to the heart.
Tricuspid Stenosis (TS): When the tricuspid valve stiffens, it becomes difficult for blood to flow out. The heart is forced to work harder, which can lead to long-term damage (heart failure).

How is Tricuspid Valve Disease Treated?

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.

Medications

Medications can address symptoms and help reduce complications of long-standing regurgitation such as pulmonary hypertension (high blood pressure in the lungs). These medications include:

Antiarrhythmics
Beta blockers
Blood thinners
Diuretics

Transcatheter Treatments (Interventional Cardiology)

These minimally invasive procedures can access the heart through the large blood vessels without traditional surgery.

Advanced cardiac imaging technology is used to guide the procedure, allowing the team to “see” the structures of the heart and circulatory system.
A guidewire is inserted into a blood vessel in the leg or neck and then guided up to the heart.
A special tube called a catheter then delivers instruments and devices up to the diseased valve.
Once in place, the devices are deployed and implanted.
Once completed, the instruments and wires are removed, and the catheter is withdrawn.

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.
Transcatheter Tricuspid Valve Replacement
- A replacement valve is placed in the opening of the diseased valve or failed replacement valve.
- The valve is then deployed, opening up while in position to take over for the diseased or failed valve.
- The replacement valve immediately takes over and starts to control blood flow.
  EVOQUE Tricuspid Valve Replacement System
  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).
Transcatheter Tricuspid Valve Repair
- A clamp-like device is inserted into the diseased valve.
- The arms of the clamp are opened and positioned to catch the valve leaflets.
- Once in place, the clamp is closed to hold the leaflets together in the middle of the valve’s opening.
- The device holds the leaflets or the valve together, creating smaller openings.
- These smaller openings help control blood flow and reduce TR.
  TriClip
  Columbia cardiologists have worked extensively on developing and refining less invasive therapeutic options to treat tricuspid valve disease. We are major participants in the TRILUMINATE trial evaluating the TriClip, an investigational clip-based transcatheter edge-to-edge repair (TEER) device for reducing symptomatic tricuspid regurgitation.
Transcatheter Electrosurgery
- An instrument with a wired loop is inserted into a damaged or misshapen valve.
- The wire uses an electrical current to cut and reshape valve leaflets and other cardiac tissue.
- The reshaped valve can now close more completely, reducing TR.

Surgery

The tricuspid valve can also be repaired or replaced using traditional open surgery with general anesthesia. The heart is accessed directly through a chest incision (sternotomy) or through a smaller incision in the side of the chest. The type of surgery performed will depend on the type and severity of the valve disease.

Robotic Valve Surgery

Robotic surgery uses a highly advanced surgical platform (robot) with articulating arms and instruments to perform complex surgeries. Guided by the surgeon working at a console, surgical robots can be used to perform valve surgery and other procedures through very small incisions with a very high level of precision.

Types of Tricuspid Valve Surgery include:

Tricuspid Valve Repair
- The valve’s leaflets are reshaped or separated. An annuloplasty ring may also be implanted to restore the shape or tighten the base of the valve.
Tricuspid Valve Replacement
- The damaged valve is surgically removed and replaced with a mechanical or biological tissue valve.

Hybrid 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
Reduced scarring

Because these procedures combine elements of open surgery and transcatheter procedures, they require the careful coordination of an experienced team of experts.

Recovery

Recovery from tricuspid valve treatment will vary based on several factors, including:

The type of treatment
The severity of disease
Additional heart conditions
Previous surgeries
Age
Overall health

Patients may also take medications after treatment to avoid infections and reduce the risk of vascular complications like stroke.

Next Steps

Tricuspid Valve Disease can have a significant impact on your overall health and quality of life, and getting treated is just part of the plan. Tricuspid valve disease is often found with other types of heart valve disease, and can lead to serious health problems like heart failure and stroke. So, it’s essential to work with your cardiologist and valve care team to monitor and manage your long-term heart health.

Columbia is a world leader for heart valve care, with the expertise and experience to support your needs for years to come. To learn more about partnering with the Columbia Structural Heart and Valve Center for your care, call us at (212) 342-0444 or complete our online appointment application form.

We accept most major insurance plans and can verify your plan when you call to make your appointment.