Surgeons risk losing ground as transcatheter tricuspid valve interventions rise

Editor’s Note

At the Society of Thoracic Surgeons (STS) annual meeting, experts urged cardiac surgeons to become more engaged in tricuspid valve treatment before transcatheter options gain too much traction according to a January 26 report in MedPage Today.

With new transcatheter devices gaining FDA approval and the Centers for Medicare & Medicaid Services (CMS) proposing coverage policies that diminish the role of surgeons in patient evaluation, the urgency for surgical involvement is growing, the outlet reports. Historically, patients with tricuspid regurgitation (TR) were often considered poor candidates for surgery due to their older age and high-risk profiles. The introduction of devices like the Evoque tricuspid valve replacement system and the TriClip transcatheter edge-to-edge repair (TEER) device in 2024 has changed the treatment landscape. However, the devices have yet to show a survival benefit at one year, and concerns remain regarding thrombosis, durability, and the need for reintervention.

CMS’s proposed National Coverage Determination for transcatheter tricuspid valve replacement departs from the model established for transcatheter aortic valve replacement (TAVR), removing the requirement for cardiac surgeons to play an equal role with interventional cardiologists in determining patient suitability, MedPage reports. Some surgeons attribute this shift to their own lack of engagement, as they have often deferred patient evaluations to cardiologists. Without greater involvement, they warn, surgery will be relegated to addressing failed transcatheter cases rather than being a primary treatment option.

The full report offers additional context on patient selection and defining risk. Other reporting from MedPage on the STS Meeting covers the use of tissue valves for younger patients as well as a debate over the use of inhaled pulmonary vasodilators for surgery.