CPT® Code 0646T

Transcatheter tricuspid valve implantation (TTVI)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed

Transcatheter tricuspid valve implantation (TTVI) or replacement with a prosthetic valve is a minimally invasive procedure aimed at addressing severe tricuspid valve (TV) regurgitation, a condition where the tricuspid valve does not close properly, allowing blood to flow backward into the right atrium. This procedure is performed using a percutaneous approach, which means it is done through the skin, typically via the femoral vein, rather than through open-heart surgery. Various devices have been developed for TTVI, including annuloplasty devices, leaflet/coaptation devices, and valve replacement devices, each designed to reduce the severity of regurgitation through different mechanisms. For instance, coaptation devices may work by plicating the valve leaflets or by using a spacer to occupy the valve orifice, thereby improving closure. The procedure is generally conducted under general anesthesia and requires the use of multiple imaging modalities to guide the intervention accurately. A commonly utilized TTVI device features a steerable guide catheter (SGC) and a clip delivery system (CDS), which includes a steerable sleeve and a chrome-cobalt clip with articulated arms designed to grasp and draw the valve leaflets together. The procedure may employ techniques such as the triple-orifice technique, where clips are placed between the septal and anterior tricuspid leaflets as well as between the septal and posterior leaflets, or the bicuspidization technique, which focuses on the septal and anterior leaflets. The initial steps involve approximating the leaflets with a clip, followed by the careful placement of additional clips to ensure proper alignment and closure. Throughout the procedure, anticoagulation with heparin is administered to prevent thrombus formation, and careful monitoring is conducted to verify the effectiveness of the intervention before finalizing the clip deployment and removing the delivery system.