A New Valve for an Old Heart: Transcatheter Replacement Enters the Mainstream
A recent analysis in *Heart* examines the evidence and adoption pathway for transcatheter tricuspid valve replacement (TTVR), a minimally invasive procedure for severe tricuspid regurgitation (TR). With untreated severe TR carrying a 70% four-year mortality rate and affecting about 4% of people over 75, this intervention addresses a critical unmet need. The article details the recent FDA approval of the EVOQUE system via the Breakthrough Devices Programme and its provisional coverage by Medicare, contingent on further evidence development. It positions TTVR as a vital new option alongside traditional surgery and clipping, particularly for patients who are not surgical candidates or have unsuitable anatomy for clips, marking a significant shift in the management of right-sided valvular heart disease.
Why it might matter to you: For cardiologists and heart teams, this represents a tangible expansion of the therapeutic arsenal for a high-mortality condition. Understanding the evidence landscape and reimbursement pathways for TTVR is now essential for comprehensive patient counseling and procedural planning. This development directly influences clinical decision trees for valvular heart disease, requiring integration of this new technology into existing treatment algorithms for heart failure and structural interventions.
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