Revolutionary care for heart valve patients


In this article:

  • Tricuspid valve regurgitation occurs when your tricuspid valve doesn't close properly, allowing blood to leak backward.

  • The condition causes weakness, excessive fatigue, swelling and shortness of breath. Until recently, care options were severely limited or didn’t exist.

  • Swedish is participating in a clinical research trial that brings a revolutionary minimally invasive treatment to people with tricuspid valve regurgitation.  Learn more about this revolutionary treatment for patients with heart valve disease.

When you have a heart valve disease, weakness, fatigue, swelling and shortness of breath are often an expected part of your daily “normal.” And safe, effective treatment options offering long-lasting relief without debilitating side effects just don’t exist.

Until now.

The team of specialists who make up the Structural Heart and Valve Disease Program at Swedish recently began offering a treatment option that gives new hope to people with tricuspid valve regurgitation, a condition that affects their blood flow. Until now, many of them had few, if any, available treatment options. To date, two patients have had this potentially life-changing procedure at Swedish through our participation in the TRISCEND II Pivotal Clinical Trial.

"By working closely with clinical research, our team can bring our lessons and learnings to help people in Seattle, Washington and beyond. Patients deserve the best care options and those options are here at Swedish,” says Sameer A. Gafoor, M.D., medical director, structural heart disease at Swedish.

Dr. Gafoor is part of a team of experts, including Santanu Biswas, M.D. and Sidakpal Panaich, M.D. and a wide range of physicians, nurses, care providers and administrative staff at the Structural Heart and Valve Disease Program. All have advanced expertise in helping people with heart valve disease improve their quality of life. Their close working relationships and collaborative approach gets results.

What is tricuspid valve regurgitation?

Your heart has four sections or chambers. The two upper chambers are the left and right atrium and the two bottom chambers are the left and right ventricles. The upper and lower chambers are connected and linked with valves. The valve that separates your right ventricle and right atrium is called the tricuspid valve.

“The function of these valves is to make sure that blood goes through the body without going backward,” says Dr. Biswas. “In heart valve disease, valves fail in one of two ways. They either don't open or they don't close.”

Tricuspid valve regurgitation occurs when the tricuspid valve doesn't close properly, allowing the blood to flow in the wrong direction. If left untreated, the condition may lead to heart failure.

“Patients are not always aware they have tricuspid valve regurgitation,” adds Dr. Biswas. “But when the tricuspid valve leaks, it can cause symptoms of bloating, fullness, leg swelling, shortness of breath, fatigue and a host of other symptoms.”

Treating the “forgotten” valve 

Traditionally, treatment options for tricuspid valve regurgitation have been limited, according to Dr. Panaich.

“Many physicians have long considered the right ventricle and tricuspid regurgitation as ‘the forgotten valve’ because there were not many effective treatment options for the vast majority of patients,” he explains.

People can have various levels of tricuspid regurgitation and the treatment options vary according to your unique needs, goals and health history.

“The first option is often medical therapy,” says Dr. Gafoor. “Many patients are placed on water pills and the medication helps. However, quite a few patients do not get the full benefit from water pills or have issues with water pills. The leakage of the tricuspid valve causes pressure on the liver and the kidneys. And this causes problems for people who cannot eliminate that excess fluid buildup.”

Surgery is another option but patients with severe valve issues are often poor candidates for an invasive procedure.

“We often find that many people are too sick to have these surgeries. Some of it has to do with their heart. Some of it has to do with other conditions that make them too frail. Or they may have other organs that were damaged from having open heart surgery, therefore increasing their risk,” explains Dr. Panaich.

“Transcatheter therapy increases the treatment options for these patients. It gives them hope where none existed,” adds Dr. Biswas.

Revolutionary care brings remarkable results

Through the TRISCEND II trial, Swedish is evaluating the EVOQUE tricuspid valve replacement system. Earlier treatment repaired a faulty valve with a device that clipped the valves together. With EVOQUE, the valve is replaced completely through a minimally-invasive procedure that uses a small incision in your leg to access your heart. Patients typically go home the next day, according to Dr. Gafoor.

“Transcatheter therapy for this type of condition is really a revolutionary step forward for these types of patients and their families,” says Dr. Gafoor. “By improving quality of life, we've added life to people's years.”

Shaping care for future generations

“Swedish is at the forefront of therapy for structural heart disease,” says Dr. Gafoor. “Adding transcatheter therapy to our arsenal of treatment tools allows us to offer options for valve repair and replacement that may not be available at other hospitals or facilities.”

Participation in the TRISCEND II trial is a natural extension of the team’s dedication to improving treatment through clinical research, according to Dr. Gafoor. The team has been a part of several critical studies, including:

  • The TRILUMINATE trial was the first major study to look at repairing the tricuspid valve using a device called a MitraClip™.
  • The COAPT trial was the first to test surgical valve replacement for patients who had not responded well to medication.
  • The EVEREST trial compared traditional mitral valve surgery and MitraClip™ treatment to determine which produced the best results.

“At Swedish, we not only take care of patients today, we shape care of patients for tomorrow,’ says Dr. Biswas. “Every pathway for care that we have in medicine – whether it's a medication, a procedure, a surgery or a way of doing things – often exists because it's been rigorously evaluated and critiqued to get the best possible outcome.”

“We want to make sure that we're doing the right thing for each patient. Not just because we think so. But because we can prove it to be so,” says Dr. Panaich. “Clinical research makes that possible.”

“Research allows many things,” agrees Dr. Gafoor. “It gives us a chance to bring innovative technologies and therapies to patients that would otherwise not have options. It allows us to make sure that those technologies and therapies are held to the highest possible standard for safety and efficacy. And finally, it allows us to make sure that what we do today doesn’t just impact the patients in front of us. Our efforts impact patients beyond our borders and beyond the year 2023 into the future.”


Learn more and find a provider

Are you looking for answers about your heart health? Contact the experts at the Swedish Heart & Vascular Institute at 206-320-4100 to learn more about the cardiac care we offer that can make a lasting difference in your life.

Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction, and follow up as needed. If you need to find a provider, you can use our provider directory.

Join our Patient and Family Advisory Council. 

Related resources 

Swedish research at the forefront of new advances in heart health

Milestone in procedure to fix leaky hearts

Recognizing a cardiac emergency. What should you do?

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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About the Author

The Swedish Heart & Vascular Team is committed to bringing you many years of expertise and experience to help you understand how to prevent, treat and recover from cardiovascular diseases and conditions. From tips to eating better to exercise and everything in between, our clinical experts know how to help you help your heart.

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