Percutaneous tricuspid annuloplasty

Severe tricuspid regurgitation (TR) is a common problem, affecting approximately 1.6 million Americans, with the majority (85%) of TR being functional in nature. When left untreated, TR is associated with progressive right-sided heart failure, with a poor prognosis entailing high morbidity and mortality. Surgical repair is still the gold standard for TR, but only a small proportion of patients undergo surgical repair leaving a high clinical demand for alternatives to conventional surgery. Percutaneous repair and replacement of cardiac valves have exponentially advanced in the past decade, including transcatheter tricuspid valve repair. There are still anatomical challenges that need to be addressed when performing a percutaneous transcatheter annuloplasty compared to a surgical annuloplasty, such as approach, access, landing zone, proximal structures and visibility. Current percutaneous annuloplasty systems either obtain a direct (Cardioband) or indirect (TriCinch and Trialign) annuloplasty. Both direct and indirect percutaneous annuloplasties are modeled after surgical experiences. This review will investigate novel direct and indirect transcatheter annuloplasty devices for repair of severe tricuspid regurgitation.