Novel procedure provides tricuspid valve repair without surgery

Dr Robert Smith

Consultant Interventional Cardiologist, Royal Brompton and Harefield Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust

New minimally invasive procedures can repair tricuspid valve regurgitation, a potentially serious heart condition — and avoid the need for open-heart surgery.

There’s a good reason why the tricuspid heart valve is known as ‘the forgotten valve’, notes Dr Robert Smith, consultant interventional cardiologist based at Royal Brompton and Harefield hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust. “Traditionally, if the valve leaks or fails, little can be done to treat it,” he says.

Tricuspid valve regurgitation consequences

Despite being historically overlooked, the tricuspid valve is crucial to heart health. A leak of the valve — known as tricuspid valve regurgitation — is common. It’s thought to affect up to 5% of the population in the UK aged over 75 and may be due to various factors including age and atrial fibrillation (AF). “However, severe cases are associated with significant mortality,” warns Dr Smith.

At an early stage, symptoms can be mild; but, as the condition worsens, patients may experience breathlessness, fatigue and swelling of the ankles and legs and, rarely, the abdomen. While diuretic medication may alleviate some symptoms, only reparative surgery can properly restore valve function. As this involves open heart surgery, it’s usually only performed while the patient is having an operation for another heart condition.

Two types of low-risk non-surgical intervention

A minimally invasive non-surgical treatment is now being used at a small number of hospitals globally, including Royal Brompton and Harefield hospitals. This could be a game-changer for patients with tricuspid valve regurgitation, particularly those who are too high-risk for open-heart tricuspid valve repair because they are older, have additional health issues or have advanced heart failure.

The procedure is performed with a catheter — a tube-like device, which delivers direct treatment to the heart via a small incision in the groin. “There are two treatments available to patients,” explains Dr Smith.

“The first is transcatheter edge-to-edge repair (TEER) where a clip is used to reduce the leak. The second is transcatheter tricuspid valve replacement (TTVR), a newer procedure where the valve is replaced and the leak is obliterated.” Both procedures are low-risk and take around two hours.

Tricuspid valve regurgitation procedure recovery

After a few days of monitoring, the patient is usually able to go home. Currently, the procedures are not available on the NHS, but Dr Smith hopes this will change. “One of our patients — who was elderly, frail and possibly facing a palliative care pathway — had the TEER procedure and, a month later, went salmon fishing,” he says. “There’s no doubt it can make a real difference to people’s lives.”