Abstract
Purpose of Review
The field of transcatheter tricuspid valve interventions (TTVI) is rapidly evolving to meet a well-defined but unmet clinical need. Severe tricuspid regurgitation is common and is associated with significant morbidity and mortality. Surgical options are limited and of high risk. The success of TTVI depends on careful procedural planning, and cardiac computed tomography (CCT) plays an emerging key role.
Recent Findings
TTVI technologies have various targets, including the leaflets, annulus, and venae cavae, along with valve replacement. Based on the planned procedure, CCT allows for device sizing, careful assessment of the access route, and comprehensive analysis of relevant adjacent anatomic structures to enhance procedural safety. It can also evaluate right-sided heart function, and its data can be for fusion imaging and 3D printing.
Summary
Procedural planning is key to TTVI’s success and is highly dependent on high-quality CCT data. This review details the comprehensive roles of CCT, specifics of the dedicated TTVI protocol, and its limitations.
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Abbreviations
- TV:
-
Tricuspid valve
- TR:
-
Tricuspid regurgitation
- TTVI:
-
Transcutaneous tricuspid valve intervention
- TVA:
-
Tricuspid valve annulus
- CCT:
-
Cardiac computed tomography
- RV:
-
Right ventricle
- VC:
-
Venae cavae
- SVC:
-
Superior vena cava
- IVC:
-
Inferior vena cava
- RCA:
-
Right coronary artery
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Topilsky Y, Maltais S, Medina Inojosa J, Oguz D, Michelena H, Maalouf J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging. 2019;12(3):433–42. https://doi.org/10.1016/j.jcmg.2018.06.014.
Otto CM, Rick Nishimura C-CA, Robert Bonow C-CO, Blase Carabello FA, John Erwin Iii FP, Federico Gentile F, et al. WRITING COMMITTEE MEMBERS* 2020 ACC/AHA guideline for the management of patients with valvular heart disease. Circulation. 2021;143:0-00, doi:https://doi.org/10.1161/CIR.0000000000000923.
Zack CJ, Fender EA, Chandrashekar P, Reddy YNV, Bennett CE, Stulak JM, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol. 2017;70(24):2953–60. https://doi.org/10.1016/j.jacc.2017.10.039.
Axtell AL, Bhambhani V, Moonsamy P, Healy EW, Picard MH, Sundt TM, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol. 2019;74(6):715–25. https://doi.org/10.1016/j.jacc.2019.04.028.
Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J. Transcatheter tricuspid valve interventions. J Am Coll Cardiol. 2018;71(25):2935–56. https://doi.org/10.1016/j.jacc.2018.04.031.
Harb SC, Kapadia SR. Patients’ selection for transcatheter tricuspid valve interventions: who will benefit? Prog Cardiovasc Dis. 2019;62(6):467–72. https://doi.org/10.1016/j.pcad.2019.09.002.
Hahn RT. State-of-the-art review of echocardiographic imaging in the evaluation and treatment of functional tricuspid regurgitation. Circulation: Cardiovascular Imaging. 2016;9(12). https://doi.org/10.1161/CIRCIMAGING.116.005332.
Kapadia S, Krishnaswamy A, Layoun H, Griffin BP, Wierup P, Schoenhagen P, et al. Tricuspid annular dimensions in patients with severe mitral regurgitation without severe tricuspid regurgitation. Cardiovascular Diagnosis Therapy. 2021;11(1):68–80. https://doi.org/10.21037/cdt-20-903Findings from this study highlight the need for early detection and intervention on the tricuspid valve in patients with mitral regurgitation, even in the absence of significant tricuspid regurgitation.
Fukuda S, Saracino G, Matsumura Y, Daimon M, Tran H, Greenberg NL, et al. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation. 2006;114(SUPPL. 1). https://doi.org/10.1161/CIRCULATIONAHA.105.000257.
Dahou A, Levin D, Reisman M, Hahn RT. Anatomy and physiology of the tricuspid valve. JACC Cardiovasc Imaging. 2019;12(3):458–68. https://doi.org/10.1016/j.jcmg.2018.07.032This paper thouroughly explains the anatomy of the tricuspid valve and its surrounding structures.
Hołda MK, Zhingre Sanchez JD, Bateman MG, Iaizzo PA. Right atrioventricular valve leaflet morphology redefined. J Am Coll Cardiol Intv. 2019;12(2):169–78. https://doi.org/10.1016/j.jcin.2018.09.029.
Agricola E, Asmarats L, Maisano F, Cavalcante JL, Liu S, Milla F, et al. Imaging for tricuspid valve repair and replacement. JACC Cardiovasc Imaging. 2020:1–51. https://doi.org/10.1016/j.jcmg.2020.01.031.
Vollroth M, Sandri M, Garbade J, Mohr FW. Severe right coronary artery injury during minimally invasive tricuspid valve repair. Eur J Cardiothorac Surg. 2015;48(3) e62-e. https://doi.org/10.1093/ejcts/ezv245.
Reid A, Ben Zekry S, Turaga M, Tarazi S, Bax JJ, Wang DD, et al. Neo-LVOT and transcatheter mitral valve replacement: expert recommendations. JACC Cardiovasc Imaging. 2020. https://doi.org/10.1016/j.jcmg.2020.09.027.
Dreyfus GD, Martin RP, Chan KMJ, Dulguerov F, Alexandrescu C. Functional tricuspid regurgitation. J Am Coll Cardiol. 2015;65(21):2331–6. https://doi.org/10.1016/j.jacc.2015.04.011.
Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic types of tricuspid regurgitation. JACC Cardiovasc Imaging. 2019;12(3):491–9. https://doi.org/10.1016/j.jcmg.2018.09.027This paper summarizes the morphologic types of tricuspid regurgitation with their different prognostic outcomes.
Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM. Cardiac implantable electronic device lead-induced tricuspid regurgitation. JACC Cardiovasc Imaging. 2019;12(4):622–36. https://doi.org/10.1016/j.jcmg.2018.09.028.
Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379(24):2307–18. https://doi.org/10.1056/nejmoa1806640.
Nickenig G, Weber M, Lurz P, Von Bardeleben RS, Sitges M, Sorajja P, et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet. 2019;394(10213):2002–11. https://doi.org/10.1016/s0140-6736(19)32600-5.
Corpataux N, Winkel MG, Kassar M, Brugger N, Windecker S, Praz F. The PASCAL device—early experience with a leaflet approximation device: what are the benefits/limitations compared with the MitraClip. Curr Cardiol Rep. 2020;22(8). https://doi.org/10.1007/s11886-020-01305-1.
Planer D, Beeri R, Danenberg HD. First-in-human transcatheter tricuspid valve repair. J Am Coll Cardiol Intv. 2020;13(18):2091–6. https://doi.org/10.1016/j.jcin.2020.05.050.
Nickenig G, Weber M, Schueler R, Hausleiter J, Näbauer M, von Bardeleben RS, et al. 6-Month outcomes of tricuspid valve reconstruction for patients with severe tricuspid regurgitation. J Am Coll Cardiol. 2019;73(15):1905–15. https://doi.org/10.1016/j.jacc.2019.01.062.
Hell MM, Emrich T, Kreidel F, Kreitner K-F, Schoepf UJ, Münzel T, et al. Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies. European Heart Journal - Cardiovascular Imaging. 2020, doi:https://doi.org/10.1093/ehjci/jeaa308.
Curio J, Demir OM, Pagnesi M, Mangieri A, Giannini F, Weisz G, et al. Update on the current landscape of transcatheter options for tricuspid regurgitation treatment. Interventional Cardiology Rev. 2019;14(2):54–61. https://doi.org/10.15420/icr.2019.5.1.
Fam NP, Ong G, Deva DP, Peterson MD. Transfemoral transcatheter tricuspid valve replacement. J Am Coll Cardiol Intv. 2020;13(10):e93–e4. https://doi.org/10.1016/j.jcin.2020.01.194.
Hahn RT, Kodali S, Fam N, Bapat V, Bartus K, Rodés-Cabau J, et al. Early multinational experience of transcatheter tricuspid valve replacement for treating severe tricuspid regurgitation. J Am Coll Cardiol Intv. 2020;13(21):2482–93. https://doi.org/10.1016/j.jcin.2020.07.008.
Lu F-L, An Z, Ma Y, Song Z-G, Cai C-L, Li B-L, et al. Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. Heart. 2021;0:heartjnl-2020-318199. https://doi.org/10.1136/heartjnl-2020-318199.
Figulla HR, Kiss K, Lauten A. Transcatheter interventions for tricuspid regurgitation - heterotopic technology: TricValve. EuroIntervention. 2016;12:Y116–Y8. https://doi.org/10.4244/EIJV12SYA32.
Toggweiler S, De Boeck B, Brinkert M, Buhmann R, Bossard M, Kobza R, et al. First-in-man implantation of the Tricento transcatheter heart valve for the treatment of severe tricuspid regurgitation. EuroIntervention. 2018;14(7):758–61. https://doi.org/10.4244/EIJ-D-18-00440.
Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation. J Am Soc Echocardiogr. 2017;30(4):303–71. https://doi.org/10.1016/j.echo.2017.01.007.
Zhan Y, Senapati A, Vejpongsa P, Xu J, Shah DJ, Nagueh SF. Comparison of echocardiographic assessment of tricuspid regurgitation against cardiovascular magnetic resonance. JACC Cardiovasc Imaging. 2020;13(7):1461–71. https://doi.org/10.1016/j.jcmg.2020.01.008.
Zhan Y, Debs D, Khan MA, Nguyen DT, Graviss EA, Khalaf S, et al. Natural history of functional tricuspid regurgitation quantified by cardiovascular magnetic resonance. J Am Coll Cardiol. 2020;76(11):1291–301. https://doi.org/10.1016/j.jacc.2020.07.036.
Pulerwitz TC, Khalique OK, Leb J, Hahn RT, Nazif TM, Leon MB, et al. Optimizing cardiac CT protocols for comprehensive acquisition prior to percutaneous MV and TV repair/replacement. JACC Cardiovasc Imaging. 2020;13(3):836–50. https://doi.org/10.1016/j.jcmg.2019.01.041This paper outlines the protocols used for optimal imaging of the tricuspid valve via cardiac CT, with focus on transcatheter tricuspid valve interventions.
Rizvi A, Deaño RC, Bachman DP, Xiong G, Min JK, Truong QA. Analysis of ventricular function by CT. J Cardiovascular Comput Tomography. 2015;9(1):1–12. https://doi.org/10.1016/j.jcct.2014.11.007.
Szilveszter B, Nagy AI, Vattay B, Apor A, Kolossváry M, Bartykowszki A, et al. Left ventricular and atrial strain imaging with cardiac computed tomography: Validation against echocardiography. J Cardiovascular Comput Tomography. 2020;14(4):363–9. https://doi.org/10.1016/j.jcct.2019.12.004.
Veulemans V, Hellhammer K, Polzin A, Bönner F, Zeus T, Kelm M. Current and future aspects of multimodal and fusion imaging in structural and coronary heart disease. Clin Res Cardiol. 2018;107(S2):49–54. https://doi.org/10.1007/s00392-018-1284-5.
Harb SC, Rodriguez LL, Svensson LG, Xu B, Elgharably H, Klatte R, et al. Pitfalls and pearls for 3-dimensional printing of the tricuspid valve in the procedural planning of percutaneous transcatheter therapies. JACC Cardiovasc Imaging. 2018;11(10):1531–4. https://doi.org/10.1016/j.jcmg.2018.05.003.
Harb SC, Rodriguez LL, Vukicevic M, Kapadia SR, Little SH. Three-dimensional printing applications in percutaneous structural heart interventions. Circulation: Cardiovascular Imaging. 2019;12(10):9014. https://doi.org/10.1161/CIRCIMAGING.119.009014.
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Dr. Puri reports personal fees from Medtronic, Bioventrix, Centerline Biomedical, and Philips and non-financial support from Boston Scientific and Products & Features, outside the submitted work. The other authors declare that they have no conflict of interest.
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Layoun, H., Schoenhagen, P., Wang, T.K.M. et al. Roles of Cardiac Computed Tomography in Guiding Transcatheter Tricuspid Valve Interventions. Curr Cardiol Rep 23, 114 (2021). https://doi.org/10.1007/s11886-021-01547-7
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DOI: https://doi.org/10.1007/s11886-021-01547-7