Heterotopic Treatment of the Tricuspid Valve

Tricuspid regurgitation (TR) has been associated to high morbimortality, mainly due to the development of cardiac failure, peripheral edema, ascites, kidney failure and cardiohepatic syndrome. 

In non-surgical patients, given the associated elevated rates of complications and mortality, percutaneous treatment has emerged as a valid alternative, transcatheter edge-to-edge repair (TEER) being the preferred strategy. 

However, in numerous cases this approach will not be feasible, which makes it necessary to resort to percutaneous valves or heterotopic treatments. 

This analysis included 20 severe or greater TR patients, symptomatic and not suitable for surgery or TEER, undergoing heterotopic treatment with the Trillium device.

Mean patient age was 81, and 8 were women. Mean TRI-SCORE was six. All patients were in functional class III-IV, with con 41 ml/min eGFR. Six presented ascites, nine chronic liver disease and six had been hospitalized for cardiac failure over the last year. Also, four presented COPD, eight had a pacemaker, they all had atrial fibrillation, two had a history of myocardial revascularization surgery (CABG) and six had undergone valve surgery. 

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Six patients had previous tricuspid valve interventions: one annuloplasty and five TEER. Tricuspid annulus diameter was 53 mm, with an 11 mm gap.

Device implantation was successful in all cases. The femoral venous approach was used and total procedural time was 22 minutes. 

At 30 days, one patients died, two were rehospitalized for cardiac failure and two presented major gastrointestinal bleeding. No patient required definite pacemaker implantation or valve surgery and there were no cases of device embolization. In addition, there was a significant reduction in central venous pressure, improved functional class, quality of life and a non-significant increase in 6-minute walk distance.

Conclusion

The Trillium was shown safe and effective for the treatment of severe or greater tricuspid regurgitation in patients ineligible for other therapies. Its use has been associated to improved hemodynamics and symptoms. However, further randomized studies are required to support these favorable results.  

Original Title: Heterotopic Crosscaval Transcatheter Tricuspid Valve Replacement for Patients With Tricuspid Regurgitation. The Trillium Device. 

Reference: Philipp Lurz,  et al. JACC Cardiovasc Interv. 2025;18:1425–1434.