Novel treatment of atrial functional tricuspid regurgitation using transcatheter bicaval valve implantation (TricValve)

Background: Transcatheter tricuspid valve intervention has recently emerged as a viable alternative to surgery for patients with symptomatic severe tricuspid regurgitation (TR). Though usually performed on the basis of compassionate grounds, we are now exploring the extension of its usage as an elective option in a patient with severe atrial functional tricuspid regurgitation. Aims: The aim of this study was to select a suitable patient and proceed with the implantation of the TricValve in order to provide symptomatic relief as well as to improve morbidity and mortality. Methods: A 67-year-old woman had underlying atrial fibrillation and severe tricuspid regurgitation. Despite optimised medical therapy, she remained symptomatic with elevated NT-proBNP levels. As the patient refused surgery on multiple occasions, we chose a percutaneous procedure guided by transoesophageal echocardiography and fluoroscopy. Results: The procedure was uneventful and the patient was discharged. At 3-month follow-up, there was marked improvement clinically and biochemically. Conclusions: Bicaval valve implantation with the TricValve is a viable alternative to surgery in patients with symptomatic severe tricuspid regurgitation. This intervention is crucial as we are now able to intervene before irreversible right ventricular dysfunction sets in.