Patients living with tricuspid valve disease have historically had few treatment options. Certain medications can alleviate symptoms but until recently the only procedures to repair or replace the tricuspid valve involved open-heart surgery. In 2024, the Food and Drug Administration (FDA) approved two groundbreaking, minimally invasive treatment options for tricuspid valve repair and replacement, giving patients long-awaited, safer options with little downtime and significant improvements in quality of life.
Physicians affiliated with Memorial Hermann-Texas Medical Center were key facilitators in the clinical trials for these new valve procedures and performed the first transcatheter tricuspid valve replacement in Texas at the Memorial Hermann-TMC campus. These innovative procedures are part of a new era of cardiac therapies, with additional therapeutic breakthroughs on the horizon.
The tricuspid valve, one of four heart valves, is located between the right atrium and right ventricle. Its job is to pump blood through the heart. If the tricuspid valve does not contract and relax effectively, blood can flow “backwards,” known as tricuspid regurgitation. When the valve does not close tightly, blood leaks into other areas of the heart with each heartbeat, which can lead to heart damage.
Tricuspid valve disease occurs more frequently with older adults and is linked to atrial fibrillation (AFib). When the condition is severe, patients often experience increased heart rate, shortness of breath, fatigue or swelling in the legs, feet or abdomen.
Some patients with mild valve disease can manage their symptoms with medication and do not need further intervention. Those with more advanced disease can now benefit from minimally invasive transcatheter interventions, instead of traditional open surgery.
The innovative T-TEER procedure repairs the faulty tricuspid valve with a clip device that restores the valve’s ability to properly open and close. Patterned after the highly successful clip device for mitral valve repair, the tricuspid clip device now provides the same solution for patients with tricuspid-valve disease.
T-TEER is performed while the patient is under general anesthesia. The cardiologist performs a percutaneous puncture, a medical procedure that involves inserting a needle through the skin to access a blood vessel. The catheter, which contains the valve-repair clip device, is then inserted through the blood vessel into the femoral vein, where it is guided to the tricuspid valve using ultrasound or echocardiogram imaging. Once the device is secured on the tricuspid valve, the guiding catheter is removed (leaving the clip device in place), and the insertion or puncture spot is closed.
The TTVR procedure is a minimally invasive therapy that replaces a faulty tricuspid valve with an artificial valve. The procedure is performed while the patient is under general anesthesia. The cardiologist inserts a needle through the skin to access the femoral vein in the groin. The catheter, which contains the artificial valve, is inserted through the opening into the femoral vein, where it is guided to the tricuspid valve, using ultrasound or echocardiogram imaging. Once the replacement valve is properly positioned, the catheter is removed, and the insertion or puncture spot is closed.
People with tricuspid valve disease who suffer with symptoms despite medication usage may be candidates for these transcatheter procedures.
Tricuspid valve disease is a mechanical problem that requires a mechanical solution. Medication may relieve symptoms for some patients, but without minimally invasive or surgical intervention, the underlying problem still exists.
Before transcatheter interventions were available, the only solution for tricuspid disease was open-heart surgery. Traditional open surgery is considered high risk for tricuspid repair or replacement, and these new catheter-based procedures are safer with minimal recovery time.
After undergoing minimally invasive tricuspid repair or replacement, patients benefit from symptom relief and significant improvement in quality of life. Additionally, patients report being more active with better breathing capacity, feeling less congested and being able to lower the dosage of diuretics they use.
Although these innovative procedures have an excellent safety profile, as with all medical procedures, there are risks involved. Some patients may experience:
Most patients spend one night in the hospital after the procedure and then are ready to go home the next day. Getting up and walking around within 24 hours of the procedure is encouraged.
After discharge from the hospital, patients may be advised to avoid strenuous physical activity for about a week and then begin to slowly build back up to their daily routine. The cardiologist will provide a referral to cardiac rehabilitation to assist with healing and strengthening to help patients enjoy a full, active life.
These groundbreaking, minimally invasive procedures demonstrate promise for the future of many types of cardiac procedures. Identifying safer ways to treat heart disease offers patients hope for living a healthier, stronger life without the need for high-risk surgical procedures.
Clinical trials have demonstrated that the T-TEER and TTVR procedures are significantly more effective than medication therapy alone and offer a much-needed alternative for patients. Other catheter-based therapies are currently undergoing trials, and experts expect additional cardiac offerings to become available in the near future.
These transcatheter therapies require a cohesive, team approach with experienced clinicians from a range of specialties, including cardiac anesthesia and interventional cardiology using advanced imaging capabilities.
Memorial Hermann is one of a few health systems with the capability to perform these leading-edge procedures at select campuses.
T-TEER and TTVR procedures are performed at Memorial Hermann-TMC;
T-TEER is performed at Memorial Hermann Memorial City Medical Center.
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