CPT® Code 0545T

1. Indications

The transcatheter tricuspid valve annulus reconstruction procedure is indicated for patients experiencing chronic tricuspid regurgitation, which is often a consequence of a dilated annulus. This condition is frequently observed in individuals with heart failure and dilated cardiomyopathies. The procedure aims to address the underlying anatomical issues contributing to the regurgitation, thereby improving cardiac function and patient outcomes.

2. Procedure

The procedure for transcatheter tricuspid valve annulus reconstruction involves several critical steps to ensure successful implantation of the adjustable annulus device. Initially, the femoral vein is punctured to gain access to the venous system. A dilator may be utilized to facilitate the widening of the femoral access site. Following this, a transseptal steerable sheath, along with the dilator, is inserted through the femoral vein and advanced over a guidewire into the right atrium, employing standard catheterization techniques. Once in position, the tip of the implantation catheter, which carries the preselected and sized annulus device, is navigated to the anterior leaflet of the tricuspid valve, specifically anterior to the aortic root segment. The catheter tip is then carefully positioned at the first deployment site on the annulus of the anterior leaflet segment. After confirming tissue contact at the appropriate angle, the first anchor of the device is deployed. The implant system is subsequently navigated to the next designated location, where the second anchor is deployed. This process is repeated until all anchors are placed. Once the final anchor is secured, the implant is disengaged and released from the catheter. To achieve optimal sizing, the size adjustment tool (SAT) is employed to reduce the tricuspid annular diameter, with regurgitation being assessed after each degree of reduction until the desired adjustment is achieved. Finally, the SAT and the implant guidewire are released from the implant, and the SAT is carefully retracted into the transseptal steerable sheath, which is then withdrawn from the body.

3. Post-Procedure

Post-procedure care for patients undergoing transcatheter tricuspid valve annulus reconstruction typically involves monitoring for any immediate complications, such as bleeding or infection at the access site. Patients may also require echocardiographic evaluation to assess the effectiveness of the annulus reconstruction and to monitor for any residual regurgitation. Follow-up appointments will be necessary to evaluate the patient's recovery and overall cardiac function, ensuring that the adjustments made during the procedure have achieved the desired outcomes. Additional considerations may include medication management and lifestyle modifications to support heart health.