Italy’s First Transcatheter Tricuspid Valve Replacement: A New Hope for Patients

A pioneering transcatheter tricuspid valve replacement – a minimally invasive procedure – has been performed at the Monaldi Hospital in Naples, Italy, offering new hope for patients suffering from severe tricuspid regurgitation. This condition, often called the “forgotten valve,” occurs when the tricuspid valve, one of the heart’s four valves, doesn’t close properly, causing blood to leak backward into the right atrium. Patients with heart failure or pulmonary hypertension are at increased risk.

A New Approach to a Historically Underestimated Condition

According to Professor Paolo Golino, Head of Cardiology at UTIC Vanvitelli, and Dr. Giovanni Ciccarelli, a member of the interventional team, these new minimally invasive procedures – including Transcatheter Edge-to-Edge Repair (TEER) and transcatheter tricuspid valve replacement (TTVR) – allow treatment for patients previously considered inoperable. These procedures avoid the need to open the heart and significantly reduce hospital stays.

Did You Know? The team at Monaldi Hospital has already performed hundreds of TEER procedures – both mitral and tricuspid – in recent years, demonstrating a commitment to advanced cardiac care.

Understanding Tricuspid Regurgitation

Dr. Ciccarelli explained that the tricuspid valve allows blood to flow from the right atrium to the right ventricle. Insufficiency occurs when the valve’s leaflets don’t seal tightly, causing blood to flow back into the atrium during contraction. There are two main types: functional (or secondary) insufficiency, more common, is caused by enlargement of the right ventricle and tricuspid annulus, often linked to heart failure or pulmonary hypertension. Organic (or primary) insufficiency can be related to rheumatic disease, congenital conditions, complications from other procedures, or endocarditis.

Minimally Invasive Procedures: A Patient-Focused Shift

The treatment for severe tricuspid insufficiency can be pharmacological, in cases of right ventricular dysfunction, or surgical. Traditional surgery remains the first choice, particularly when other heart valve issues are present. However, for patients not eligible for surgery, these new transcatheter techniques offer an alternative. Successful implementation requires specific anatomical characteristics assessed through a transesophageal echocardiogram.

Expert Insight: The development of transcatheter procedures represents a significant shift in cardiac care, prioritizing less invasive options for patients who may not be suitable candidates for traditional open-heart surgery. This approach aims to reduce risk and accelerate recovery.

Benefits Over Traditional Surgery

Dr. Maurizio Cappelli Bigazzi highlighted the advantages of these minimally invasive alternatives. TEER (using devices like Triclip and Pascal) involves inserting clips through a vein in the leg to bring the valve leaflets closer together, reducing leakage. TTVR (using devices like Evoque) involves implanting a bioprosthesis made of nitinol and bovine pericardial tissue via the femoral vein, also without open-heart surgery. Compared to traditional surgery, these procedures drastically reduce operative risk, limit hospital stays to 3-5 days, and allow for a quicker recovery.

Positive Early Results

Professor Paolo Golino reported that the Cardiology UTIC Vanvitelli department at Monaldi Hospital is a leader in percutaneous treatment of cardiac valve disease. The hospital’s leadership, under avv. Anna Iervolino, has invested in the expertise of the Interventional Cardiology team. Beginning in late 2025, a team led by Professor Golino, Maurizio Cappelli Bigazzi, Dr. Renatomaria Bianchi, Gemma Salerno, and Marco Malvezzi Caracciolo d’Aquino, assisted by cardioanesthesiologist Dr. Mariateresa Palladino and a team of nurses coordinated by Ada Orefice and Rosaria Riccardi, performed the first TTVR procedures, implanting a biological replacement valve in the tricuspid position. These procedures were complication-free, and initial data show a significant reduction in symptoms.

Frequently Asked Questions

What is tricuspid regurgitation?

It is a condition where the tricuspid valve does not close properly, causing blood to leak backward into the right atrium during heart contraction.

Who is most at risk for tricuspid regurgitation?

Patients with heart failure or pulmonary hypertension are at increased risk.

What are the two main types of tricuspid insufficiency?

The two types are functional (or secondary) and organic (or primary).

Could these advancements in minimally invasive valve replacement lead to wider adoption and improved outcomes for patients with tricuspid regurgitation in the future?