How to Fix a Leaky (Tricuspid) Heart Valve without Open Surgery (video/podcast)

Your heart pumps blood through four chambers: a left and right atrium, and a left and right ventricle. The atria take blood in from your body, and the ventricles pump it back out to the lungs.

The tricuspid valve is one of four heart valves that help ensure blood flows correctly into the atria and out of the ventricles. A leak in the tricuspid valve can cause problems ranging from a lack of energy to heart failure.

While surgery is one option to fix a leaky tricuspid valve, minimally invasive devices may offer alternative treatments for patients who can’t have surgery.

In this video, San Diego Health host Susan Taylor discusses new, less invasive approaches to fixing leaky tricuspid heart valves with Matthew Price, MD, an interventional cardiologist at Scripps Clinic Anderson Medical Pavilion in La Jolla.

The tricuspid valve ensures that blood flows correctly from the right-side atrium to the right-side ventricle.

After the blood passes through it, the tricuspid valve securely shuts to prevent blood from flowing backward into the atrium. If the valve leaks, the blood can go back into the veins instead of out to the lungs. This is called tricuspid regurgitation and can cause a variety of unpleasant or even debilitating symptoms, such as swelling of the legs, loss of appetite, liver problems and a lack of energy.

Without treatment, a severely leaky valve makes the heart work harder than normal and can raise the risk of heart failure.

While surgery for a leaky tricuspid valve is an option, it can have significant risks.

“Surgery on the tricuspid valve alone puts a lot of pressure on the side of the heart where that valve is,” says Dr. Price. “We’ve learned that people undergoing surgery just to fix the tricuspid valve are at high risk of doing poorly after the operation. This is not only because of the operation itself, but because when people have a very leaky valve, they become very frail and may not tolerate the surgery.”

Scripps interventional cardiologists use two devices to repair or replace a leaky tricuspid valve: the TriClip and a tricuspid valve replacement.

The TriClip is a clothespin-like clip that opens and closes. It is inserted using minimally invasive techniques that require only a small incision in the hip area; the device is placed inside a thin tube called a catheter and passed to the heart through a vein. The clip is then attached to the leaky valve. When the valve closes, the TriClip cinches the leaky section shut to seal the valve. Clinical research has shown the TriClip can improve quality of life and avoid the need for additional hospital care.

While the TriClip helps your existing valve do its job, the tricuspid valve replacement device completely replaces the leaky valve.

“This device can be collapsed inside of a tube, placed inside your heart and then expanded right where your old tricuspid valve is. It takes over the function of your old valve,” explains Dr. Price. “And this has been shown in a large study also to improve patient’s quality of life.”

Because both devices are implanted using minimally invasive surgical techniques, hospital stays are typically short ― overnight for the TriClip, and two to four days for the replacement device.

Moreover, neither device requires recovery time. However, since the devices are passed to the heart through an incision in the hip, patients should avoid heavy lifting for about a week, as well as stay out of the ocean for a week or so to reduce the risk of infection at the incision.

Once implanted, the devices remain in the heart for life, and further hospital stays are usually not needed.

“Scripps is a leader in these novel devices. We were a leader in the trials of the clip and the valve and have done more cases than most hospitals in the United States or the world,” says Dr. Price, who was involved in the clinical studies for both devices.

“Not only have these devices been shown to improve or fix the leakiness and improve people’s quality of life, they are much safer than surgery and get you out of the hospital much faster,” he says.

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