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

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Abstract

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.

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Abbreviations

AVN:

Atrioventricular node

RA:

Right atrium

RCA:

Right coronary artery

RV:

Right ventricle

TTVD:

Transcatheter tricuspid valve device

TV:

Tricuspid valve

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Acknowledgments

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

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Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Technology Enterprise Park, 387 Technology Circle NW, Atlanta, GA, 30313-2412, USA

    Shelly Singh-Gryzbon, Eric L. Pierce & Ajit P. Yoganathan

  2. Cardiac Implants LLC, 25 Lake Terrace, Tarrytown, NY, 10591, USA

    Andrew W. Siefert

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  1. Shelly Singh-Gryzbon
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Correspondence to Ajit P. Yoganathan.

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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.

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Singh-Gryzbon, S., Siefert, A.W., Pierce, E.L. et al. Tricuspid Valve Annular Mechanics: Interactions with and Implications for Transcatheter Devices. Cardiovasc Eng Tech 10, 193–204 (2019). https://doi.org/10.1007/s13239-019-00405-6

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