What is the TricValve?

The TricValve (P+F Products) is a transcatheter system that treats severe tricuspid regurgitation by implanting two self-expanding bioprosthetic valves into the venae cavae — one in the superior vena cava (SVC) and one in the inferior vena cava (IVC). Rather than replacing the tricuspid valve itself, the TricValve approach (also known as caval valve implantation, CAVI) prevents the backwards transmission of pressure into the venous system, reducing the symptoms caused by venous congestion.

How does it work?

Two valves are delivered on catheter systems through the femoral vein. Using a combination of x-ray and ultrasound guidance, the SVC valve is positioned and deployed first, followed by the IVC valve. Both valves are self-expanding and seat against the wall of each vena cava. When the right atrium contracts, the two caval valves close, preventing backwards transmission of pressure into the liver, abdomen and head — which addresses the most disabling symptoms of severe tricuspid regurgitation.

Who is TricValve recommended for?

TricValve is generally considered for patients with symptomatic severe tricuspid regurgitation who are unsuitable for tricuspid edge-to-edge repair (TEER) and unsuitable for direct tricuspid replacement (for example with the Evoque system), and for whom open heart surgery is also not an option. It is often particularly considered when the dominant symptoms are from venous congestion — peripheral oedema, ascites, hepatic congestion — rather than primarily from forward heart failure. The selection process is careful and individualised: TricValve is typically chosen when other options are not feasible.

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 usually includes additional investigations — typically a transthoracic echocardiogram, a transoesophageal echocardiogram (TOE), and a cardiac CT scan to size the venae cavae. 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 TricValve is the best option for you, and you would like to go ahead, we will offer you a procedure date.

What can I expect from the procedure?

The procedure is performed under general anaesthetic or deep sedation, with continuous TOE guidance. Both valves are delivered through the femoral vein. The procedure typically takes around two hours. Most patients stay in hospital for two to three nights afterwards. 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 TricValve implant reduces venous congestion, which typically translates into significantly less leg and abdominal swelling, less liver congestion, and improved breathlessness and exercise tolerance over the following weeks. Like any procedure there are risks, including bleeding from the access site, valve mispositioning, the need for further intervention, and rarely significant heart-related complications. We will discuss your individual risk profile in detail at your consultation, both verbally and in writing.

What experience does Dr Dawkins have?

Dr Dawkins is part of the structural heart programme at Cleveland Clinic London, where the full range of transcatheter tricuspid options — including TEER, transcatheter tricuspid valve replacement, and caval valve implantation with TricValve — is offered. 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.