Original Title: Transcatheter Tricuspid Valve-in-Valve Implantation for the Treatment of Dysfunctional Surgical Bioprosthetic Valve. An International, Multicenter Registry Study. Reference: Doff B. McElhinney, et al. Circulation 2016;133:1582-93

Courtesy of Dr. Carlos Fava.

Transcatheter tricuspid valve in valve implantation (TVIV) is infrequent, complex and biological valves last from 10 to 15 years. Reoperation is associated with high mortality (10% to 33%). Transcatheter valve implantation is a new strategy that has to be assessed.

This study included 152 patients with bioprosthetic TV dysfunction undergoing TVIV. 94 patients received a Melody valve and 58 received Edwards valves (12 Sapiens, 41 Sapiens XT and 5 Sapiens 3).

Mean age was 40 years old, most patients were in cardiac failure FC III/IV. Those receiving the Melody prosthesis were younger, presented more congenital heart disease and had smaller surgical valves.

The most frequent cause for implantation was the combination of stenosis and failure (47%), followed by stenosis (29%) and finally failure (24%).

Transcatheter valve implantation was successful in 150 patients; after implantation, the tricuspid mean gradient saw a significant reduction (7 mmHg to 2 mmHg; p=<0.001), this was similar for both types of prosthesis. Hospital stay was 2 days.

At 30 days, 5 patients died (in 2 patients procedure was compassionate treatment) and in 4 patients (2 of each valve) prostheses failed for moderate failure or severe stenosis.

At 13 months, 77% of patients were in functional class I-II. During this follow up period, 17 patients died, all of them evolved in functional class III-IV and 10 required reintervention.

Conclusion
Valve in valve in tricuspid position with transcatheter prostheses available at present, is technically and clinically successful in patients of different ages with a wide range of valve diameters. In addition, there was an improvement in functional class. TVIV should be considered an alternative treatment to tricuspid bioprosthetic failure.

Editorial Comment
To carry out this registry, 50 centers were required (1 to 3 patients per center and only 5 enrolled ≥5), which shows us how infrequent this pathology is.

TVIV is a reasonable and safe strategy that results in clinical improvement in this difficult management high risk group.

Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires