Tricuspid Valve TEER

What is Tricuspid Valve TEER?

TEER (with either the Pascal or TriClip device) has developed as a treatment strategy for Tricuspid Regurgitation (TR) within the last few years. The principles of tricuspid valve TEER (tTEER) are very similar to mitral valve TEER (mTEER), but the procedure can be more challenging due to the interaction of three rather than two valve leaflets. Unlike mTEER, however, treating the tricuspid valve does not involve crossing from the right to the left side of the heart (transeptal puncture). As a result, tTEER is usually undertaken at very low risk (less than 1% risk of major complication or death).

Does tTEER work?

Does TEER work?

This technique remains new and is still developing. Consequently, there are limited data to suggest it makes you live longer – although this has not yet been assessed. We know from the TRILUMINATE study that tTEER using TriClip is safe and is associated with a high success rate. The study showed a significant reduction in severity of TR and was associated with significant improvements in symptoms and quality of life measures. A randomised clinical trial of TriClip versus medical therapy is currently being undertakenNCT03904147Both TriClip and Pascal have regulatory approval in Europe (CE Mark).

Can I be treated with tricuspid TEER?

Can I be treated with tricuspid TEER?

Currently, tTEER is generally considered for patients with isolated TR (i.e. where TR is the only significant valve problem). In situations where there are problems with the left sided heart valves (aortic or mitral valves), it is normally recommended that this is addressed before considering tTEER. Surgical correction of TR remains the Gold Standard treatment but can be associated with relatively high risk in certain patients with other medical issues. The tricuspid valve is usually treated at the same time when surgery is undertaken for other valves, but we less often recommend surgery for TR alone. Consequently, tTEER has emerged as an option for patients with severe TR where surgery is felt to be at high risk or is not an option. Generally, tTEER is considered for symptomatic TR. Symptoms and signs of TR include breathlessness, lethargy, swelling of the legs and abdomen and congestion of the liver.

How is tTEER performed?

How is tTEER performed?

Dr Smith has extensive experience of tTEER with both the TriClip and Pascal system. With the assistance of colleagues at the Royal Brompton & Harefield Hospitals, he has developed one of the largest and most successful transcatheter tricuspid valve programmes in the UK.

The procedure is performed under general anaesthetic. A transoesophageal echo probe is inserted once you are asleep and guides the procedure throughout. A very small incision is made in the right groin and the guiding catheter is advanced into the right atrium and towards to tricuspid valve. The procedure usually takes about 1-2 hours. A small suture is placed in the groin once the guiding catheter is removed. You will normally return to the ward after around an hour and then go home the following day. A transthoracic ECHO (TTE) will be performed before discharge to assess the result of tTEER.

Our Team

Toufan Bahrami

Mr Toufan Bahrami is a senior consultant in cardiac surgery , working at both Royal Brompton and Harefield Hospital, where he treats both NHS and private patients.

He also works at The Harley street clinic in central London .With more than 4000 cardiac operations of which 1500 are minimally invasive procedures over past 21 years, He is the   only consultant in UK expert in all aspects of minimally invasive cardiac surgery including , Mitral , Aortic valve and root and CABG with a longstanding track record.

Saeed Mirsadraee

Dr Mirsadraee’s specialist interest is cardiovascular imaging and in particular imaging of the heart valves, surgical and transcatheter aortic and mitral valve procedure planning, and complex aortic conditions. He is the radiology lead for aortic and mitral imaging at the Royal Brompton and Harefield hospitals. Dr Mirsadraee uses CT images in planning Mitral valve procedures such as minimal access mitral valve surgery, transcatheter mitral valve implantation (eg. Tendyne, Sapien in ring/MAC), cord and left ventricular remodelling procedures (eg. Accucinch, Neocord).

Ali Vazir

Dr Ali Vazir is a consultant cardiologist based at the Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust. He is also an Honorary Clinical Senior Lecturer at National Heart and Lung Institute, Imperial College London. 

He is an expert in heart failure and echocardiography. He is the clinical lead for heart failure at the Royal Brompton Hospital. He trained in London and was a Post-doctoral research fellow at the Brigham and Women’s Hospital and Harvard Medical School, Boston, USA. He is a principal investigator for several multicenter trials. 

Lauren Connolly

Lauren has worked within the cardiology and cardiac surgery care setting for seven years. In recent years she has worked within the structural heart team as clinical nurse specialist and co-ordinator for the trans catheter team, specifically focusing in mitral and tricuspid valve disease.

Dr Robert Smith

Dr Smith’s specialist interest is Mitral valve disease and interventions. He leads one of the largest structural heart disease programmes in Europe at the world renowned Royal Brompton & Harefield Hospitals. It is also the first centre of excellence for MitraClip in the world.
  1. Nickenig G., Weber M., Lurz P., et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet 2019;394(10213):2002–11. Doi: https://doi.org/10.1016/S0140-6736(19)32600-5.