Transcatheter edge-to-edge tricuspid valve repair (TriClip)

The tricuspid valve lies in the right side of the heart, between the right atrium and right ventricle. When it leaks severely, blood flows back into the veins: swollen legs, a swollen abdomen, a congested liver, fatigue and breathlessness. Tricuspid regurgitation is often linked to enlargement of the right heart, atrial fibrillation or pacemaker leads. Isolated tricuspid valve surgery is often a major operation in these patients. Transcatheter edge-to-edge repair applies to the tricuspid valve the same principle as for the mitral valve: one or more small clips bring the leaflets together to reduce the leak. The system is brought through the femoral vein at the groin to the right side of the heart, without crossing the wall between the atria. The procedure is performed under general anaesthesia, guided by transoesophageal echocardiography and X-ray imaging. The indication is decided by a multidisciplinary team (the "heart team") for patients with severe tricuspid regurgitation and symptoms despite well-conducted medical treatment, especially diuretics, when surgery is considered high risk and the valve anatomy is suitable. It is a more recent technique whose main aim is to improve symptoms and quality of life. At Clinique Pasteur Tunis, the decision is based on this joint discussion, and the procedure brings together interventional cardiologists, an echocardiographer and anaesthetists, in a latest-generation catheterisation laboratory, with cardiac intensive care on site.