Key trends in transcatheter tricuspid valve interventions
Tricuspid valve disease has long been an underdiagnosed and undertreated condition, but advancements in transcatheter interventions are set to change that. Steven Bolling, MD, director of the Multidisciplinary Mitral Valve Clinic and professor of cardiac surgery at the University of Michigan, spoke on this topic in sessions at the Cardiovascular Research Technologies (CRT) 2025 meeting. He spoke with Cardiovascular Business to provided an overview of the tricuspid space, discussing key trends and future directions in the field.
"Tricuspid valve disease is grotesquely undertreated, both in the cardiac surgical arena and in the cardiology arena. And I think it is really ripe for percutaneous intervention," Bolling explained.
For years, he said the valve was largely ignored because it was assumed that treating the mitral valve would indirectly improve tricuspid regurgitation. However, data over the years have proven that approach ineffective, and treatment strategies have evolved significantly. Today, even in isolated tricuspid valve cases, surgical outcomes have improved, with the Society of Thoracic Surgeons (STS) reporting a 4-5% mortality rate, a marked improvement from earlier years. Despite these advancements, Bolling emphasized transcatheter interventions recently cleared by the U.S. Food and Drug Administration and new devices in development will likely have a major impact on more patients being screened and sent for treatment.
Transcatheter annuloplasy ring is on the wish list from surgeons
One thing that Bolling and other cardiac surgeons would like to see added to their tool box is transcatheter tricuspid annuloplasty rings, which make up most of the surgical tricuspid procedures.
"As a surgeon, we have made that patient really pay the ultimate price. We put them on bypass, we open the sternum, and 90-95% of the time we put in an annuloplasty ring. It works really well. We're actually moving the anterior tricuspid leaflet against the septum, and so that ends up being very efficacious. So my choice for a patient for annuloplasty, so I'd like to see a percutaneous tricuspid annuloplasty device," Bolling said.
He said some annuloplasty devices are in development, including the Amend device presented in an innovation session at CRT. He said the biggest challenge is imaging the device during deployment and ease of use. While the CardioBand was tested as the first transcatheter annuloplasty band, he said they were very difficult to use and having good enough imaging to navigate and deploy the device was also an issue.
"I think this is really a ripe area to go upstream in those patients. Right now, we're only operating on patients who have one foot in the grave and one foot on a banana peel," he explained, adding that a transcatheter device would be much less invasive and help these very sick patients recover.
Tricuspid interventions struggle to show efficacy, but do show QOL improvement
One of the key challenges in tricuspid interventions has been demonstrating clinical efficacy. Unlike transcatheter aortic valve replacement (TAVR), which has shown clear mortality benefits, tricuspid trials have struggled to provide definitive clinical outcome improvements. Many studies rely on patient-reported quality-of-life (QOL) measures such as the Kansas City Cardiomyopathy Questionnaire (KCCQ), rather than hard clinical endpoints. Despite this, patients report significant improvements in daily function and symptom relief post-procedure.
Another challenge lies in device development. Bolling said the currently approved devices, the Abbott TriClip and the Edwards Lifesciences Evoque valve, originated as adaptations of mitral valve technologies. However, the anatomical and physiological differences between the mitral and tricuspid valves present unique challenges. The tricuspid valve is thinner and more delicate than the mitral valve, making durability and imaging during procedures more difficult. He did say that CRT 2025 showcased promising second-generation devices specifically designed for the tricuspid valve, signaling a shift toward dedicated solutions.
The increased focus on tricuspid valve disease has also led to a rise in surgical volumes, mirroring trends seen in TAVR over the past decade. As interest in structural heart disease grows, both cardiologists and surgeons are seeing more referrals, ultimately benefiting patients by expanding available treatment options.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com