The necessity for surgeons to embrace transcatheter tricuspid valve therapy

Figures

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  Stepwise pathway for surgeon integration into tricuspid heart teams.

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  Figure 1. Timeline of evolution of transcatheter tricuspid interventions and evolving role of cardiac surgeons in this context. Development of technology in parallel with changes in the level of surgeons' participation throughout history, emphasizing the importance of surgical involvement in current transcatheter heart teams. TR, Tricuspid regurgitation; TEER, transcatheter edge-to-edge repair; TTVR, transcatheter tricuspid valve replacement.

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  Figure 2. Clinical outcomes and complications after transcatheter tricuspid valve replacement in the real world. Thirty-day clinical event rates after transcatheter tricuspid valve replacement using the EVOQUE system from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry.9Orange bars illustrate complications that are pertinent to the practice of cardiac surgeons, such as device migration (0.6%), device embolization (0.1%), and unplanned cardiac surgery/intervention (2.2%). The complication composite with clinical relevance to surgery (2.9%) is the cumulative rate for these particular intraprocedural or postprocedural structural events.

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  Figure 3. Self-reinforcing cycle of limited cardiac surgeon engagement in transcatheter therapies for the tricuspid valve. Diagram explaining how low exposure and lack of knowledge contribute to low participation and engagement, resulting in the program becoming exclusively interventional cardiology–led.

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  Figure 4. Patient care pathway with emphasis on cardiac surgeon engagement during critical phases. Diagram highlighting the importance of the cardiac surgeon involvement throughout diagnosis, planning, procedure, complications, and follow-up in patients with tricuspid-valve disease. TR, Tricuspid regurgitation; TEER, transcatheter edge-to-edge repair; TTVR, transcatheter tricuspid valve replacement.