Tricuspid insufficiency (TI) is a disease of the tricuspid valve, quite common and associated with a poor prognosis. It affects approximately 0.8% of the general population. Its incidence increases markedly with age. 4% of patients over 75 are affected. Since April 4, 2024, Poitiers University Hospital has been offering a new treatment: the TripClip technique (Abbott Cardiovascular).
Tricuspid insufficiency is linked to a leak in the tricuspid valve[1] located between the right atrium and the right ventricle, leading to abnormal reflux of blood from the right ventricle to the right atrium. In 85% of cases, it is functional and, most frequently, secondary to a pathology of the left heart (valvular disease of the left heart, failure of the left ventricle): an arrhythmia due to atrial fibrillation, pulmonary disease, pulmonary hypertension, or the presence of a cardiac stimulation probe (pace maker or defibrillator). Pathologies of the left heart ultimately cause dilation of the right heart chambers, favoring the occurrence and worsening of tricuspid insufficiency.
Severe tricuspid regurgitation leads to the appearance of signs of right heart failure with weight gain linked to water retention, shortness of breath, fatigue, and lower limb edema. It facilitates the occurrence of rhythm disorders, renal and hepatic failure. It therefore leads to repeated hospitalizations with a very poor quality of life. At an advanced stage, severe tricuspid regurgitation is associated with a poor prognosis with a mortality rate close to 60% at one year, directly correlated to the degree of tricuspid leakage.
In practice, conventional cardiac surgery, recommended for the treatment of severe tricuspid insufficiency, is rarely performed (5%) due to the high surgical risk (one-month mortality estimated between 8 and 10%). Since April 4, the Poitiers University Hospital has been using the TriClip technique for percutaneous valve repair, which constitutes a therapeutic alternative in symptomatic patients, despite optimal medical treatment and considered at high surgical risk. It is aimed at patients suffering from tricuspid insufficiency not eligible for conventional surgical treatment. This new technique is offered thanks to specific financing, this system not yet being reimbursed by Social Security. It is carried out by Drs Jean Mergy and Elisa Larrieu, cardiologists, in close collaboration with Doctors Corinne Beaufort and Benjamin Alos, sonographers.
The TriClip system is directly inspired by the MitraClip system (edge-to-edge repair of the mitral valve) which has demonstrated its effectiveness and safety in the treatment of mitral insufficiency for several years.
The goal of the TriClip technique is to restore the valve leaflets to a tight fit in the leak area using clips, or “clamps,” and thus reduce the tricuspid leak. It is performed by inserting a catheter equipped with the clip through a femoral vein, at the level of the groin crease, under general anesthesia, without the need for a chest opening and therefore without a sternotomy. General anesthesia is motivated by the need for transesophageal ultrasound during the procedure to guide the placement of the clips on the tricuspid valve. Depending on the anatomy and the type of tricuspid leak, the implantation of several clips is often necessary. TriClip treatment has shown a reduction in tricuspid leak associated with a decrease in heart failure symptoms, allowing an improvement in the patient’s quality of life and a decrease in hospitalizations..
The TriClip device is an innovative treatment. It makes it possible to offer a real possibility of repair of the tricuspid valve in symptomatic patients, who suffer from tricuspid insufficiency despite well-conducted medical treatment and who cannot benefit from cardiac surgery due to a significant surgical risk.
[1] The tricuspid valve is one of the four valves that make up the heart along with the pulmonary, aortic and mitral valves.
Photos from Abbott lab.
Share the post “TripClip Technique for Treating Tricuspid Insufficiency”
