5.2 TEER vs. Tricuspid Valve Replacement: Where To Go Following TRILUMINATE

These proceedings summarize the educational activity of the 17th Biennial Meeting of the International Andreas Gruentzig Society held January 30 to February 2, 2024 in Chiang Rai, Thailand.

Faculty Disclosures     Vendor Acknowledgments

2024 IAGS Summary Document

Statement of the problem or issue

At the time of this presentation, there were no FDA-approved tricuspid devices in the USA. However, shortly after this presentation was made, both the Edwards EVOQUE transcatheter tricuspid valve and the Abbott TriClip received FDA approval for use in the USA. There are a few with CE mark in Europe, including the TriClip (2020), the PASCAL clip (2022), and the EVOQUE transcatheter valve replacement (2023) (Figure).

Figure. Tricuspid Clips and Transcatheter Tricuspid Valve.

In addition to these devices, there are also the CardioBand, Intrepid valve, TricValve, and Sapien valve family, but they are all infrequently used or remain in early stage trials.

Gaps in current knowledge

The largest gaps in knowledge are:

1. Which device for which patient at what moment?
2. Can left-sided valve procedures (TAVR, M-TEER, etc.) be combined with a tricuspid valve procedure?
3. What are the appropriate endpoints for clinical trials?
4. Do we need more devices, or more clinical trials of existing devices?
5. How should advanced imaging techniques, including 3D-ICE, cCTA, and cMRI be integrated into valve therapies?

Possible solutions and future directions

Many more devices are under development currently, ranging from benchtop models to early clinical feasibility studies. Subgroup analyses of existing and future trials will help refine the questions and point out new directions. Multimodality imaging protocols will be explored and perfected. Relevant clinical endpoints will be determined. Antiplatelet and anticoagulant regimens will be defined. Surveillance protocols and imaging modalities for both pre- and post-procedure will be established. The future is wide open and much remains to be done.

References

1. Sorajja P, Whisenant B, Hamid N, et al. Transcatheter repair for patients with tricuspid regurgitation. N Engl J Med. 2023;388(20):1833-1842. doi: 10.1056/NEJMoa2300525
2. Kodali S, Hahn RT, Makkar R, et al. Transfemoral tricuspid valve replacement and one-year outcomes: the TRISCEND study. Eur Heart J. 2023;44(46):4862-4873. doi: 10.1093/eurheartj/ehad667