Approved by the Food and Drug Administration earlier this year, transcatheter tricuspid edge-to-edge repair is now performed by Johns Hopkins’ cardiothoracic surgeons and interventional cardiologists. Though the treatment is available at many medical institutions, due to Johns Hopkins team members’ vast experience in minimally invasive transcatheter techniques and imaging, the group is arguably among the best qualified nationally to employ this operation in the care of patients with leaky tricuspid valves.

The procedure is a viable alternative to open heart surgery, which many patients can’t undergo because they are elderly or have comorbidities. Using a catheter to deliver clips that lock valve leaflets together, clinicians skilled in this technique offer promise for patients.

“This is a new era of therapy,” says Johns Hopkins interventional cardiologist Rani Hasan, “and addressing the tricuspid valve through a transcatheter approach will one day be standard of care. For a lot of patients, this will mean a much better quality of life than previously possible.”

Johns Hopkins physicians have been at the forefront of transcatheter approaches — including transcatheter aortic valve replacement and replacement or repair of leaky or stenotic mitral valves using transcatheter technology, including mitral valve transcatheter edge-to-edge repair. As a surgical referral center with James Gammie, surgeon-in-chief, at its helm, Johns Hopkins may have the most experience in Maryland in these procedures. A critical member of the care team is Mary Beth Brady, a cardiac anesthesiologist who is also an international leader in imaging for such approaches.

“90% of the work in these procedures is imaging,” Hasan says. “Our work in this area has facilitated our success, both on an investigational basis and in our development of standards of care.”

For example, the team uses transesophageal echo imaging and augments it with 3D intracardiac echocardiographic imaging, which allows clinicians to see the moving parts of the valve they grasp while implanting the device.

Transcatheter tricuspid edge-to-edge repair works similarly to transcatheter mitral valve repair. A catheter is inserted through the femoral vein, and clinicians move down from the right atrium into the right ventricle, using one to three devices to clip two of the valve’s leaflets together to reduce leakage.

Hasan says their use of the approach has been shown to improve heart failure outcomes and the quality of patients’ lives.

Johns Hopkins was recently a site for a clinical trial for the transcatheter tricuspid edge-to-edge repair device, giving the team early experience with the technology. Studies showed that outcomes were best at centers with high volumes of mitral valve transcatheter edge-to-edge repairs. The Johns Hopkins team is a leader in the mid-Atlantic region for the procedure.

In addition to the benefit of the institutions’ surgical and imaging expertise, patients referred to Johns Hopkins receive individualized medical management in collaboration with referring cardiologists and physicians.

To refer a patient, call 443-997-0270.