How are you taking part in this consultation?

You will not be able to change how you comment later.

You must be signed in to answer questions

    The content on this page is not current guidance and is only for the purposes of the consultation process.

    Interventional procedure overview of transcatheter tricuspid valve leaflet repair for tricuspid regurgitation

    Closed for comments This consultation ended on at   Request commenting lead permission

    Description of the procedure

    Indications and current treatment

    Tricuspid regurgitation occurs when the tricuspid valve does not close properly during systole, and blood flows backwards through the valve. It can be caused by a problem with the valve itself (primary), but it is more commonly secondary to an underlying cardiac problem that has caused the heart to become dilated. This has the effect of stretching the annulus that supports the valve leaflets to such an extent that the leaflets do not meet and regurgitation of blood occurs.

    People with mild tricuspid regurgitation do not usually have any symptoms. If the regurgitation is severe, there may be fatigue and weakness, active pulsing in the neck veins, an enlarged liver, ascites, peripheral oedema and renal impairment. Pulmonary hypertension may develop.

    Treatment may not be needed if there are no or mild symptoms. Symptoms of heart failure are managed with diuretics and other medications. Medication to reduce pulmonary artery pressure or pulmonary vascular resistance, or both, may be used when there is severe functional tricuspid regurgitation and severe pulmonary hypertension.

    People with severe symptoms may have surgery to repair or replace the tricuspid valve. Isolated tricuspid valve surgery is rarely done. More commonly, it is done at the same time as left-sided valve surgery (mitral and aortic).

    What the procedure involves

    Transcatheter tricuspid valve leaflet repair for tricuspid regurgitation is designed to improve the function of the tricuspid valve with less morbidity and mortality than conventional surgical valve repair. It has been proposed as an option when conventional surgery poses a high risk. The procedure aims to reduce regurgitation, improve quality of life and reduce hospital admissions related to heart failure.

    The procedure is done under general anaesthesia using transoesophageal echocardiography and fluoroscopy guidance. Access is through the femoral or jugular vein.

    Different systems have been used and exact details of the technique vary. A delivery system is used to introduce a device into the heart that can grip the leaflets of the tricuspid valve and bring them closer together. The device is then released from the delivery system. Adequate reduction of tricuspid regurgitation is assessed using echocardiography.

    Outcome measures

    NYHA functional class

    The NYHA functional class is used to classify heart failure according to severity of symptoms and limitation of physical activity:

    • Class 1 - no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, breathlessness, or palpitations.

    • Class 2 - slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

    • Class 3 - marked limitation of physical activity. Comfortable at rest but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

    • Class 4 - unable to carry out any physical activity without discomfort. Symptoms at rest can be present. If any physical activity is done, discomfort is increased.

    KCCQ

    The KCCQ is a 23-item self-administered questionnaire that measures the patient's perception of their health status, including heart failure symptoms, effect on physical and social function and how their heart failure affects their quality of life within a 2-week recall period. Scores are scaled from 0 to 100, where higher scores represent better health status.