Interventional procedure overview of caval valve implantation for tricuspid regurgitation

What the procedure involves

CAVI is indicated for haemodynamically significant TR and caval reflux of tricuspid valve in people who have advanced disease (with severe leaflet tethering and a large coaptation gap) and are at extreme risk from surgery. The aim is to reduce caval reflux and stop venous congestion, so improving symptoms of heart failure and quality of life for people who cannot have open heart surgery.

The procedure is done under local or general anaesthesia, and with fluoroscopy guidance. Transoesophageal echocardiography may be used to monitor the position and function of the deployed bioprostheses. Depending on the anatomical suitability, CAVI can be single or bicaval. The bioprostheses can be dedicated self-expandable valves or balloon-expandable prostheses used for TAVR. They are implanted percutaneously through a delivery system using transfemoral access. The valves are implanted in the IVC, SVC or both, at the level of the atriocaval junction. This is done without disturbing the native tricuspid valve in a cranial-caudal direction.