Rediscovered and Unforgotten: Transcatheter Interventions for the Treatment of Severe Tricuspid Valve Regurgitation

Tricuspid valve regurgitation is both globally prevalent and undertreated. Historically, surgical intervention for isolated tricuspid regurgitation (TR) was avoided despite the prevalence of TR, largely due to poor surgical outcomes and an incomplete understanding of how it independently affects mortality. Over the past two decades, TR has been shown by several studies to be an independent predictor of worse functional status and poor survival on long-term follow-up. During this same time period, transcatheter interventions for the treatment of valvular heart disease have evolved dramatically. While the transcatheter repair and replacement of the tricuspid valve in patients with severe TR remains in the early stages of investigation relative to the mitral or aortic valve, the field is rapidly expanding. Here, the authors review the field of transcatheter tricuspid valve interventions for severe TR, focusing on the orthotropic devices and valves currently available worldwide.

Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

Endovascular interventions in main renal artery pathologies: an overview and update

Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. This article provides a comprehensive review of the role of interventional radiologists in transcatheter interventions in various pathologies involving the main renal arteries with analysis of epidemiology, pathophysiology, newer interventional techniques, and management options.

Tricuspid and pulmonary valve disease

Right heart valves have gained significant interest in the context of a plethora of new emerging percutaneous transcatheter interventions for treating tricuspid and pulmonary valve diseases. Multimodality imaging is pivotal for patient diagnosis, management, and prognosis, as well as for planning interventional and surgical valve procedures. Echocardiography is the primary imaging modality for initial diagnosis and longitudinal follow-up of patients with right-sided valvular heart disease. Cardiovascular magnetic resonance has emerged as a complementary or alternative modality for providing diagnostic information on the tricuspid and pulmonary valve anatomy, and particularly on the pulmonary artery and the consequences on the right ventricle. This chapter highlights the current use of various imaging modalities for the state-of-the-art assessment of right-sided valvular heart diseases, with emphasis on the main clinical indications, as well as on the strengths and limitations of each modality.

A systematic review of patient baseline characteristics, procedural details and outcomes of combined transcatheter valvular interventions.

Background Valvular heart pathologies remain amongst the most encountered conditions surgeons and interventionists face today. Multi-valve procedures exhibit higher operative mortality than do single valve procedures, with a mortality rate that is double its counterpart. Up until recently, surgical repair was the gold standard for most diseased valves. With the advent of new percutaneous and transcatheter technologies for valve replacement, many patients deemed inoperable due to prohibitively high surgical risk have been able to benefit from these new lesser invasive techniques. Currently, one systematic review article exists by Ando et al which included 37 studies and 60 patients and demonstrated reasonable clinical outcomes in patients undergoing combined transcatheter aortic and mitral valve intervention (CTAMVI). Since that original article, many new papers and studies have been published. We purpose an updated systematic review of all cases of combined percutaneous/transcatheter multi-valvular repairs.Methods An electronic search will be performed in PubMed, EMBASE, and Cochrane through September 2020 to identify eligible observation studies and RCTs. A complete electronic search will be conducted from January 1st 2000 to September 1st 2020 with Pubmed, EMBASE and Cochrane. All search results will be uploaded to COVIDENCE and screened by title or abstract and included for full manuscript review when it’s deemed relevant to the systematic review. All data will be abstracted into a dedicated excel spreadsheet and used for further data analysis. Demographic information such as patient’s age, sex and location will be extracted. Further information such as performed procedure, surgical risk, whether procedures were done simultaneously or staged, deployed device and clinical outcomes will be extracted as well. Discussion Within the medical literature, there is limited data available regarding combined transcatheter aortic, mitral, and tricuspid valve intervention. This is an attractive alternative in high-surgical risk patients with combined valvular disease. However, its procedural details and clinical outcomes have not been well described in any current medical guidelines. Through our systematic review we will be able to better elucidate and a establish strategies for undergoing transcatheter interventions in high risk patients who require multi-valvular repair.