What is tricuspid edge-to-edge repair?
Transcatheter tricuspid edge-to-edge repair (TEER) is a technique used to treat a leaking tricuspid valve (tricuspid regurgitation) without open heart surgery.
Dr Dawkins uses both the Pascal and TriClip devices for these procedures.
How does tricuspid edge-to-edge repair work?
A repair device (Pascal or TriClip) is delivered on its delivery system (a long steerable tube) into one of the veins in the leg. It is steered into the right side of the heart using x-rays and ultrasound. The tricuspid valve leaflets are grasped over the leak and the device is closed. If this has reduced the leak sufficiently, then the clip can be released. If not, the clip can be moved or re-orientated as needed. Most patients need more than one clip, depending on the size and location of the leak. In most patients, tricuspid regurgitation can be reduced from severe (or torrential) to moderate or less.
Who is tricuspid edge-to-edge repair recommended for?
Tricuspid TEER is currently recommended for patients with symptomatic (usually breathlessness, fatigue, leg swelling or abdominal swelling) severe tricuspid regurgitation who are at increased risk for open heart surgery. There are many reasons why someone may be at increased risk for open heart surgery — for example, previous heart surgery, other significant medical problems (e.g. liver, kidney or lung disease), atrial fibrillation, the presence of pacemaker or defibrillator leads, or frailty. The right ventricle and the rest of the heart need to be functioning well enough for the procedure to be likely to help, which is one of the things we assess carefully in the work-up.
What is the process for deciding to treat someone with this technique?
Generally you would be referred by your GP or cardiologist. You would then be assessed in clinic by Dr Dawkins, which may include additional investigations — typically a transthoracic echocardiogram, a transoesophageal echocardiogram (TOE), and a cardiac CT scan. Once we have all the necessary information, we will discuss you at one of our regular structural valve meetings. These are attended by interventional cardiologists, cardiac surgeons, imaging experts and anaesthetists. If the consensus is that this would be a good treatment for you, and you would like to go ahead, we will offer you a procedure date.
What can I expect from the procedure?
We can generally arrange the procedure within a few weeks. Most patients are admitted on the morning of the procedure. The procedure is carried out under general anaesthetic (you will be asleep) with continuous transoesophageal echocardiogram (TOE) guidance. The procedure usually takes between two and three hours. Afterwards, you will wake up on our recovery ward and will then be transferred back to the ward. Most patients stay in hospital for one to two nights. Dr Dawkins will see you in clinic a month or so after the procedure, but can be contacted in the interim if you have any queries or problems.
What are the benefits and risks?
A successful procedure reduces the severity of tricuspid regurgitation, which usually translates into improved breathlessness, less leg and abdominal swelling, and better exercise tolerance over the following weeks and months. Like any procedure there are risks, including bleeding from the access site, valve injury, the need for further intervention, and rarely stroke or significant heart-related complications. We will discuss your individual risk profile in detail at your consultation, both verbally and in writing, and again before the procedure.
What experience does Dr Dawkins have in tricuspid edge-to-edge repair?
Dr Dawkins has expertise in transcatheter tricuspid valve intervention, in particular the use of the Pascal and TriClip devices to treat severe tricuspid regurgitation. He has lectured on transcatheter tricuspid intervention at the British Heart Valve Society Annual Meeting and contributes to research and teaching on percutaneous tricuspid valve treatment.