Transcatheter Tricuspid Valve Replacement

Abstract New transcatheter technologies for the treatment of severe tricuspid insufficiency, in patients at high surgical risk, are demonstrating promising efficacy and a high safety profile. In certain conditions of advanced right failure, with significant tethering of the leaflets, repair techniques are not the ideal solution, reporting a fair rate of residual insufficiency. In this context, transcatheter tricuspid replacement could be a very attractive and effective solution. An accurate multimodality imaging analysis of the right function represents a sine qua non condition, in order to prevent fatal post-operative ventricular dysfunction (valve replacement leads to an immediate abolition of tricuspid insufficiency and subsequent afterload mismatch). This manuscript will illustrate the procedure of transcatheter tricuspid replacement with the GATE System (NaviGate Cardiac Structures, Inc., Lake Forest, CA), step by step. Other transcatheter replacement technologies, analogous to the GATE, are currently being developed and will produce further results in the near future. The evolution of imaging techniques will contribute to the further development of these therapies.