Tricuspid Valve Annular Mechanics: Interactions with and Implications for Transcatheter Devices

  • Shelly Singh-Gryzbon
  • Andrew W. Siefert
  • Eric L. Pierce
  • Ajit P. YoganathanEmail author


In the interventional treatment of tricuspid valve regurgitation, the majority of prosthetic devices interact with or are implanted to the tricuspid valve annulus. For new transcatheter technologies, there exists a growing body of clinical experience, literature, and professional discourse related to the difficulties in delivering, securing, and sustaining the function of these devices within the dynamic tricuspid annulus. Many of the difficulties arise from circumstances not encountered in open-heart surgery, namely; a non-arrested heart, indirect visualization, and a reliance on non-suture-based methods. These challenges require the application of procedural techniques or system designs to account for tricuspid annular motion, forces, and underlying tissue strength. Improved knowledge in these interactions will support the goals of improving device systems, their procedures, and patient outcomes. This review aims to describe current concepts of tricuspid annular mechanics, key device and procedural implications, and highlight current knowledge gaps for future consideration.


Tricuspid regurgitation Percutaneous repair Transcatheter devices Annular biomechanics 



Atrioventricular node


Right atrium


Right coronary artery


Right ventricle


Transcatheter tricuspid valve device


Tricuspid valve



The authors would like to acknowledge the histological work performed by Dr. Renu Virmani of CV Path in Gaithersburg, Maryland.

Compliance with Ethical Standards

Conflict of interest

Shelly Singh-Gryzbon, Eric L. Pierce and Ajit P. Yoganathan have no conflicts of interest relevant to this review article. Andrew W. Siefert is an employee of Cardiac Implants LLC.

Ethical Approval

No human or animal studies were carried out by the authors for this article.


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Copyright information

© Biomedical Engineering Society 2019

Authors and Affiliations

  • Shelly Singh-Gryzbon
    • 1
  • Andrew W. Siefert
    • 2
  • Eric L. Pierce
    • 1
  • Ajit P. Yoganathan
    • 1
    Email author
  1. 1.Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology & Emory University, Technology Enterprise ParkAtlantaUSA
  2. 2.Cardiac Implants LLCTarrytownUSA

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