#9 Mitral and Tricuspid Valve Percutaneous Replacement

Overview

You feel its beat in your chest every day. It pounds while you bike up a steep hill, it pulses slowly as you drift to sleep at night, it flutters when you fall in love. The heart is one of the most vital organs. Responsible for supplying blood to the entirety of the body, your heart provides the oxygen and nutrients your cells need to survive. But the heart is prone to an array of problems – and we’re not talking about the dreaded broken heart. The heart can suffer from a variety of conditions affecting its muscle, valves, and/or rhythm. Many of its plaguing conditions may eventually require interventional cardiac surgery.

Historically, cardiac surgery has been known as complicated and dangerous. In its early years, surgery on the heart was extremely invasive, high risk, and yielded only minimal improvement in function. But the history of cardiac surgery has shaped its future, paving the way for innovation in the space.

Today, surgery on the heart is less invasive in nature and though still risky, is more routine and effective. Many cardiac procedures are now conducted percutaneously – via a catheter through the skin. A minimally invasive approach, percutaneous cardiac intervention is an effective alternative to cumbersome open heart surgery – especially for high risk patients. Percutaneous surgery has been game-changing in aortic valve intervention. Efficient for both valve repair and replacement, innovation in the percutaneous transcatheter surgery space has expanded to include replacements of the mitral and tricuspid valves.

The mitral valve controls blood flow from the left atrium to the left ventricle of the heart, allowing blood to flow in one direction through the heart and into the body. The tricuspid valve functions to prevent back flow of blood form the right ventricle into the right atrium to further ensure blood flow in one direction. When either of these valves are faulty, blood flow is compromised and the patient’s health is negatively affected. Unattended dysfunction in said valves can lead to severe consequences such as heart failure. Often valves are damaged past the point of repair and are required to be replaced.

Mitral valve insufficiencies that may require valve replacement surgery include mitral valve prolapse, regurgitation, or stenosis. To remedy these issues, a replacement valve stent is inserted in the percutaneous manner. Currently, several companies have stake in the mitral valve replacement market with a number of approved stent models being used in patients and a number of positive outcomes reported. Use of these devices has intensified in recent years and is expected to become increasingly mainstream due to their great success.

Though percutaneous procedures for the tricuspid valve are fewer and farther between, the technology in this space is novel and filling a void in the field of heart surgery. Performed for the first time in 2016, the world’s first implantation of a tricuspid valve stent under compassionate use protocols has shown excellent maintenance of valvular function and is expected to drive the demand for transcatheter tricuspid heart valve devices. The exploration of this technology in a greater patient population is ongoing, but with promising post-op results, the innovation has astounding implications for the future of cardiac care.
 

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