Cedars-Sinai Blog
Maximizing Quality of Life With Minimally Invasive Tricuspid Care
It’s hard to climb the stairs. You’re out of breath in normal conversations, you’ve got swollen ankles and you’re constantly exhausted.
The doctor diagnosed you with tricuspid valve regurgitation—when blood flows back up into the upper right chamber of the heart (atrium) from the lower right chamber (ventricle)—and said there’s not much they can offer, other than medication.
But the medicines haven’t helped. The only other option, the doctor says, is open-heart surgery.
Patients in this position should know: Minimally invasive, lower-risk options are available if you know what to look for.
Open-Heart Surgery Isn’t the Only Option for Tricuspid Valve Regurgitation
As many as 1.6 million Americans have symptoms caused by tricuspid valve regurgitation. Medications are a good choice for some, but until recently, the only solution for others was open-heart surgery. While it can be effective, this major surgery carries risks of bleeding, needing a pacemaker, a return of symptoms, and even death.
Now, patients who have persistent symptoms caused by their tricuspid regurgitation may qualify for minimally invasive treatment options.
“These options have been game-changing for a lot of patients, many of whom are not good candidates for surgery because of their age or other health conditions,” said Raj Makkar, MD, associate director of the Smidt Heart Institute and vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai. “Doing minimally invasive repairs or replacements improves symptoms, daily function and quality of life.”
Rajendra R. Makkar, MD
Choosing the Right Minimally Invasive Tricuspid Valve Treatment
Multiple options for tricuspid regurgitation allow patients to get treatment without open-heart surgery. These typically allow patients to heal faster and head home sooner. At Cedars-Sinai, minimally invasive options include:
- Transcatheter tricuspid valve replacement (TTVR) allows the doctor to put in a replacement valve without stopping the heart or using the heart-lung bypass machine, as is common in open-heart surgery. The new valve is inserted through a small tube (catheter) through a blood vessel near the groin, and is passed up to the heart. TTVR can quickly normalize even the most severe regurgitation.
- Transcatheter edge-to-edge repair (TEER) also uses a catheter inserted near the groin. The doctor places a clip on the leaky valve to hold it partially shut. This reduces the backward flow of blood. While TEER does not totally stop regurgitation, it can make a big difference in symptoms and is considered very safe.
- Minimally invasive surgery involves a number of incisions that are smaller than those used in open-heart surgery, and can be a good fit for patients whose heart anatomy isn’t right for transcatheter methods.
Both TTVR and TEER options allow patients to go home the same day or the day after the procedure.
“Transcatheter repair can offer major improvements in quality of life and lasting reductions in tricuspid regurgitation,” said Makkar, who is the Karsh Distinguished Chair in Interventional Cardiology at Cedars-Sinai. “In most cases, we suggest repair if it is appropriate because it is very safe, but there are some clinical or anatomic reasons that may make replacement the better choice.”
Taking a thoughtful approach to procedure selection is essential. If a repair fails to improve symptoms, patients may not be good candidates for a valve replacement down the line.
“Repair changes the valve’s anatomy,” explained Makkar. “It doesn’t mean a patient can never undergo a replacement, but a lot of institutions won’t even try one because the procedure becomes more complex.”
This is why careful consideration of all minimally invasive options—and an individual patient’s likelihood of success with each—weigh heavily in care planning at the Smidt Heart Institute.
“Transcatheter repair can offer major improvements in quality of life and lasting reductions in tricuspid regurgitation.”
Choosing the Minimally Invasive Tricuspid Care Team
In addition to appropriate selection of the treatment approach, the clinical team’s experience level matters. At Cedars-Sinai, patients are in good hands. The physicians at the Smidt Heart Institute have performed more than 250 TEER procedures and more TTVRs than any other institution in the world.
“We are very proud to be world leaders in minimally invasive tricuspid valve repair and replacement,” said Makkar.
He served as the Cedars-Sinai leader of the international clinical trial that led to the approval of the world’s first transcatheter tricuspid valve replacement device, called the Edwards EVOQUE. He has been implanting these devices and other new options ever since.
The team’s experience means they can accept some of the most challenging cases, such as patients turned down elsewhere for intervention—and those with pacemakers or complicated anatomy.
At Cedars-Sinai, tricuspid regurgitation patients get a thorough review of their heart health and medical history, as well as same-day, on-site imaging of their heart’s anatomy. The goal is to safely restore quality of life so patients can get back the energy and comfort they deserve.
Virtual second opinions offer patients from distant locations the chance to have their case reviewed without leaving home.
“We have multiple devices approved for use in patients who previously had very little hope of improving their symptoms, and we are just getting started,” said Makkar. “I think we are going to continue seeing wins for these patients, improvements in outcomes and safer ways to make a lasting difference in their health and quality of life, without the need for surgery.”
