Tricvalve, a safer option for right heart valve treatment

This article is written in conjunction with World Heart Day 2021 on Sept 29.

KUALA LUMPUR – Leaky heart valves or what is medically termed as tricuspid regurgitation (TR), are fairly common. If you or your loved one has TR, you are not alone as there are options when it comes to treatment.

Of Malaysia’s population of about 32 million, an estimated 100,000 to 150,000 patients (about 0.005 per cent) really require the treatment.

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TR is a disorder in which the tricuspid valve does not close tight enough. This problem causes blood to flow backwards into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts and in severe condition into the superior and inferior vena cava (SVC and IVC). The venae cavae are the two largest veins in the body.

Patients with TR usually only go for check-ups when the symptoms become intolerable, and usually that is in the severe stage. Most of the noticeable symptoms may include fatigue, declining exercise capacity, and swelling in the abdomen. Untreated, the condition can lead to right heart failure.

Common condition

National Heart Institute (IJN) Chief Executive Officer and Senior Consultant Cardiologist Datuk Dr Aizai Azan Abdul Rahim said, TR is actually a very common heart condition in any population, including Malaysia.

He said most of the patients who seek treatment at the IJN’s Heart Failure & Heart Transplant clinic are diagnosed with the condition after an echocardiogram during check-up.

Usually, patients with mild tricuspid regurgitation are managed with medication to remove fluids from the body and to relieve the symptoms due to congestion, he noted.

“However, many of these patients who came in are in the severe stage of TR, making them high risk for open-heart surgery. Thus, IJN’s doctors have to opt for a more innovative and minimally invasive treatment for these patients who are deemed too risky for open-heart surgery or annuloplasty or clipping,” he told Bernama when contacted recently.

Dr Aizai Azan said IJN had addressed this need with a much safer option for right heart valve treatment.

The national heart institute recently announced that it has achieved another remarkable milestone as the first hospital in Asia to successfully perform a new type of treatment using the Tricvalve Transcatheter Bicaval Valves system (Bioprosthesis).

Revolutionary heart treatment

Dr Aizai Azan also said theTricValve is a minimally invasive procedure that involves implanting two valves at the superior and inferior vena cava. The bioprosthesis is a dry stent valve on a preloaded delivery system.

“The TricValve system is specifically developed for patients who suffer from severe tricuspid regurgitation, particularly those who are unable to control their symptoms through other treatments and are deemed too high-risk for surgery,” he said.

The first procedure was successfully carried out at IJN by the Heart Failure and Heart Transplant Team and Cardiology Department on May 6.

“The 67-year-old female patient is healthier than ever and now can do much more regular activities, compared to the time when she was referred for the treatment after being diagnosed with TR,” he noted.

Dr Aizai Azan also expressed his gratitude to the IJN team for seeking out newer and more innovative methods of treatment, as it is eventually benefitting the public and the nation as well.

“It is no secret that IJN’s success has been built on the willingness of our staff to keep learning and exploring new innovative treatments that can enhance our patients’ quality of life and pushing the boundaries to be able to treat more patients who are deemed unsuitable for surgeries.

“Today, IJN is reckoned to be among the best medical centres for cardiovascular and thoracic care in Malaysia and the region. IJN has kept abreast with the latest medical advances, from handling a simple hole-in-the-heart surgery to heart and lungs transplantations.

“With a strong commitment to be a global heart care centre of excellence, IJN has paved the way by creating many “firsts” for cardiovascular and thoracic care in the country, and the same goes for the innovation of the TricValve system,” he said.

Best option available

Meanwhile, IJN Clinical Director for Heart Failure & Heart Transplant, Datuk Dr Azmee Mohd Ghazi said, not all patients are able to withstand the risks of surgery or may have other conditions that make them unsuitable for certain procedures.

“For instance, a common surgical option for tricuspid regurgitation is annuloplasty, a procedure that tightens the ring around the valve in the heart. Unfortunately, in patients with severely dilated tricuspid annulus or with prior pacemaker or other underlying conditions, they will not be suitable for such procedures.

“For such cases, it is important that we are able to offer a new innovative and minimally invasive treatment like TricValve to help more patients alleviate their symptoms and improve their quality of life,” he said.

Dr Azmee also said that the dual-valve system is developed for a minimally invasive procedure and offers a quicker recovery period for patients with symptomatic severe tricuspid regurgitation. Hence, the learning curve for doctors is relatively fast, and the procedure can be performed effectively while ensuring patient safety.

“The TricValve is developed for the treatment of caval reflux present in severe cases, without touching the native tricuspid valve. It provides a new treatment option for patients who are not suitable for surgery, patients with very dilated annulus or very large coaptation gap, as well as those with a pacemaker.

“The bioprosthesis is implanted at the superior vena cava and inferior vena cava to avoid backflow in the heart, reduce congestion and promote right ventricle remodelling and increase cardiac output. Hence, improving the patient’s quality of life and walking distance.

“Furthermore, the duration of the procedure itself takes only around 30 minutes, which is much faster than the annuloplasty procedure that usually would take about five hours.

“There is no need to worry about the effectiveness of the treatment, as the TricValve Transcatheter Bicaval Valves System is one of a kind, as the revolutionary treatment has been granted European Cconformity (CE) approval in May 2021,” he noted.

On the selection of patients for such treatment, Dr Azmee said the screening has to be done extensively, because technically, it is those symptomatic patients who are not stable enough for conventional surgery who will usually be given high priority.

On the impact the TricValve will have on Malaysia’s medical tourism industry, he said such procedures would benefit everyone. More international patients are expected to seek treatment in the country once international borders are re-opened when the COVID-19 pandemic shows significant recovery, he added.

Meanwhile, IJN Head of Cardiology Department and Senior Consultant Cardiologist, Dr Shaiful Azmi Yahaya, concurred with Dr Azmee who expects encouraging response from overseas patients for TricValve, given that IJN is the first centre in Asia to perform such procedure.

When IJN became the first medical healthcare centre in Malaysia to perform the Transcatheter Aortic Valve Implantations (TAVI) in 2009, many patients from Indonesia, Pakistan and Vietnam came to Malaysia for the treatment, he added.