Page 43 - Journal of Structural Heart Disease Volume 1, Issue 3

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Original Scientific Article
future be extended to tricuspid valve as well.
Challenges
The large diameter, dynamic and highly variable na- ture of tricuspid annulus with the relatively poor fibro skeletal support is an important limitation [49, 50]. With limited annular contractile property in contrast to the mitral annulus, it is important to assess load indepen- dent indices of right ventricular contractility especially of the sub-annular fibers. The minimum required RV contractility to ensure a good closing volume, the mini- mum required cardiac output and possibly RA contrac- tility to ensure adequate opening of the valve without clogging and maintain long-term durability is yet to be defined. The need for a low profile self-expanding valve that may reach an outer diameter of 70 mm as known in patients with clinically significant and func- tional tricuspid regurgitation is another challenge. An ideal length of the covered stent is also important to prevent inadvertent encroachment of the tricuspid valve apparatus and its neighborhood including right ventricular outflow tract. Other challenges include cre- ating a stable landing zone in native valves, preventing stent fracture and paravalvular leaks.
The exponential increase in right and left sided val- vular interventions may possibly unfold the natural and unnatural history of primary and secondary tricuspid annular dilation and help our understanding for the creation of a stable, self expanding percutaneous valve with minimal paravalvar leak. Demonstrating a safe and economically viable strategy with good long-term out- comes may also be required as the devices evolve.
Conclusion
Over the past decade, there has been a paradigm shift in the interventional armamentarium for the
Video 13.
3D CT performed in a patient following a CAVI proce- dure. (Lauten, Circ Cardiovasc Interv. 2014;7:268-72).
management of valvular disease with the introduc- tion of newer, safer and low profile percutaneous valves. While the indications for percutaneous valve implantations at the aortic and pulmonary position are expanding, there has been very limited growth on the front of percutaneous treatment of tricuspid valve diseases. In selected patients with high surgi- cal risk, initial results of percutaneous tricuspid valve treatment is encouraging for various valvular sub- strates such as native valves, annuloplasty rings and bioprosthesis. Evolving strategies with newer per- cutaneous valves for eligible patients with tricuspid valve failure is likely to improve outcomes if done in a timely manner before the onset of irreversible right ventricular pump failure and may even reduce the need for a right ventricular assist device.
Conflict of Interest
Younes Boudjemline is a Proctor for Medtronic Inc.
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