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Back to Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

National Coverage Analysis (NCA) View Public Comments

Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

CAG-00468N

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Public Comments

Total Comments: 7

Commenter	Comment Information
Quader, Nishath	Date: 04/10/2025 Comment: The presence of an interventional echocardiographer is crucial to guide these procedures. The T-TEER intra procedural team should comprise of an implanting physician and an interventional echocardiographer. This is different than a multimodality imager.
Shavelle, David	Title: MD Organization: Long Beach Medical Center Date: 04/09/2025 Comment: I have been involved and performing tricuspid clip procedures for approximately 6 years. I am the Director of Cardiology and the Cardiac Catheterization Laboratory at a large Community Hospital in an underserved community. We have 6 adjacent hospitals that do not have a valve program or provide TEER. We have large numbers of patients with advanced heart failure and severe tricuspid regurgitation (TR) that are failing medical therapy. The ability to treat these patients with TriClip has significantly improved the patient's quality of life and recurrent admissions for heart failure. This statement is not true for all patients but is true for the majority (80%) of patients we have treated. For patients not responding to diuretic therapy, whom are not surgical candidates (which is the majority), Triclip offers a valuable treatment option. Team members should be similar to TEER of the mitral valve and include a heart failure specialist, a surgeon with expertise in valve surgery and an imaging specialist. We have also used intra cardiac echocardiography (ICE) for most of our cases. Additional awareness of severe TR to our HF and Electrophysiology Partners is required. We receive a significant number of referrals from both. Less I have been involved and performing tricuspid clip procedures for approximately 6 years. I am the Director of Cardiology and the Cardiac Catheterization Laboratory at a large Community Hospital in an underserved community. We have 6 adjacent hospitals that do not have a valve program or provide TEER. We have large numbers of patients with advanced heart failure and severe tricuspid regurgitation (TR) that are failing medical therapy. The ability to treat these patients with TriClip has More
Abela, Oliver	Title: MD Organization: AHVC Date: 04/07/2025 Comment: Access to this technology for symptomatic patients is important to reduce suffering from heart failure. Team should be similar to TEER mitral valve edge to edge repair but only to assist in helping these patients not as road blocks. Payers CMS and support should also not be road blocks to this patient care.
DON, CREIGHTON	Organization: University of Washington Date: 04/05/2025 Comment: The electrophysiologist should not be a mandatory part of the heart team in evaluating and managing tTEER. They can be consulted in specific cases, but their input should not be required for determining which patients to treat and how to treat them.
Ramee, MD, Stephen	Title: Medical Director, Heart Valve Services Organization: LCMC Health New Orleans Date: 04/05/2025 Comment: I am a Structural Cardiologist with over 35 years experience and tricuspid TEER investigator. I also have experience with Evoque Tricuspid Valve Replacement. We need both therapies available to take care of Medicare patients with severe tricuspid valve regurgitation who have no other options because the limitations of Evoque TTVR do not apply to Tricuspid TEER. I am fully in support of the trcuspid medical approval.
Ambrosia, Alphonse	Title: Interventional Cardiologist Organization: CVAM Date: 04/05/2025 Comment: Honorable members, As an interventional cardiologist who helped develop the structural heart program at Banner Heart hospital in Mesa with the introduction of TAVR in 2011, I support national coverage for the treatment of tricuspid insufficiency with devices used for edge to edge repair of the tricuspid valve. There are many patients in our practice who are limited by their valvular insufficiency and require repeat admissions to the hospital and multiple visits to our heart failure clinic who can have their lives dramatically improved with this therapy. Surgical tricuspid valve procedures have failed to be durable and have posed significant risk to patients for decades and are rarely used, leaving patients with no option other than medical therapy and deteriorating quality of life. Please consider coverage for this therapy which will significantly impact our patients. Sincerely, Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist Chairman of Structural Heart Committee Banner Heart Hospital Mesa, Arizona Less Honorable members, As an interventional cardiologist who helped develop the structural heart program at Banner Heart hospital in Mesa with the introduction of TAVR in 2011, I support national coverage for the treatment of tricuspid insufficiency with devices used for edge to edge repair of the tricuspid valve. There are many patients in our practice who are limited by their valvular insufficiency and require repeat admissions to the hospital and multiple visits to our heart failure More
Sachs, George M.	Title: T-TEER Approval by Medicare Date: 04/03/2025 Comment: Medicare should approve this procedure if the studies submitted in support of the Application are well designed, have a sufficiently large sample and the investigators do not have conflicts of interest that may have skewed their data and reported results. George Schs

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