**3.2 Percutaneous tricuspid valve replacement**

### *3.2.1 Orthotopic tricuspid valve implantation*

Orthotopic TTVI implies TV replacement and the prosthesis is anchored to the native ring and leaflets. To date, there are three devices available: GATE, LUX-VALVE, TRISOL and EVOQUE (**Figure 4A**-**C**).

#### a.GATE

The GATE (NaviGate Cardiac Structures, Lake Forest, CA, USA) is a self-expanding valve dedicated for placement in the tricuspid position. This is a conical shaped device with three pericardial leaflets surrounded by a nitinol stent that has twelve atrial winglets and ventricular graspers to ensure anchoring. The device comes in 5 different sizes (36, 40, 44, 48 and 52 mm in diameter) and the procedure can be performed via transjugular or through a minithoracot-

**Figure 4.** *A: Gate, B: Lux-valve, C: TRISOL, D: Edwards SAPIEN, E: TRICVALVE, F: TRICENTO.*

omy access. The first reported compassionate use of this system in 35 patients recorded a procedural success rate of 76%, with residual TR ≤ 2+ in all cases, and need for surgery in 14% with a 14% 30-day mortality [53]. A multicenter registry has been recently published including 30 patients with severe TR and right ventricular dysfunction in which the GATE system [54]. Technical success was achieved in 87%, but device malpositioning occurred in 4 patients, with conversion to open heart surgery in 2 of them (5%). Among those who received the device, 76% had mild or less TR at discharge with an in-hospital mortality was 10%. In addition, at 6-months follow-up, 62% of the patients were in NYHA I or II with no late device-related adverse events were documented.
