How to Avoid Open-Heart Surgery if You Have Leaky Tricuspid Valve

UCSF surgeons among the first in nation to conduct minimally invasive cardiac procedure to improve patients’ quality of life.

By Melinda Krigel

UC San Francisco interventional cardiologists and interventional echocardiographers recently performed the health system’s first commercial transcatheter tricuspid valve replacement procedure using the Edwards EVOQUE system. The novel and minimally invasive cardiac procedure was recently approved for use within the U.S. by the Food and Drug Administration. The UCSF team is the first to perform the commercial procedure across the UC system and in San Francisco, and is one of only a handful of centers currently performing the procedure nationally.
The EVOQUE tricuspid valve replacement system is a device designed to treat patients with severe leaking of the tricuspid valve, known as tricuspid regurgitation, without open heart surgery. The EVOQUE valve is implanted using a minimally invasive delivery system (a catheter) through the femoral vein reaching to the heart.

“Patients suffering with debilitating symptoms as a result of tricuspid regurgitation represent a large and significantly underserved patient group,” said Sammy Elmariah, MD, UCSF chief of Interventional Cardiology. “The EVOQUE tricuspid valve replacement system represents a major advance for a group of patients who previously had limited treatment options.”

Tricuspid regurgitation occurs when the tricuspid valve in the heart does not close completely, usually because the valve or surrounding structures have dilated or stretched, preventing the valve leaflets from closing tightly. Blood then flows backwards within the heart and may cause symptoms such as shortness of breath and swelling in the abdomen, legs or veins in the neck.

“Tricuspid regurgitation can cause right heart failure in a patient population previously without great options,” said Richard Cheng, MD, a UCSF interventional cardiologist and advanced heart failure specialist. “While tricuspid regurgitation can often be alleviated by treatment of underlying causes, transcatheter tricuspid valve replacement is a powerful tool to not only alleviate but obliterate the disease.”

UCSF’s multidisciplinary heart valve team began performing the tricuspid valve replacement procedure using the Edwards Lifesciences EVOQUE system in 2023, as part of the TRISCEND II clinical trial evaluating the safety and effectiveness of the EVOQUE system.

In addition to minimally invasive tricuspid valve replacement, Elmariah and the interventional cardiology team are also investigating how to increase access to other heart valve disease treatments and improve patient involvement in the management of their own care.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit Follow UCSF Health on Facebook or on Twitter.