New Light on the ‘Forsaken Valve’

Tricuspid regurgitation is frequent and mostly secondary to right ventricle and tricuspid annulus dilation. Tricuspid regurgitation has been associated to mortality increase, even though historically the importance of this valve has been disregarded compared to the other three.

Comienza a surgir evidencia positiva para la “válvula olvidada”

Tricuspid surgical repair has seen good results, but it is mostly done in the context of another valve repair. Isolated tricuspid valve repair is rare and involves risks due to comorbidities such as right ventricle dysfunction, pulmonary hypertension and prior heart surgery.

 

The FORMA system (Edwards Lifesciences, Irvine, California) is a device that provides a surface for the coaptation of the valve’s native leaflets by reducing the regurgitant orifice.


Also Read: Tricuspid Valve Repair with MitraClip”.


The work included 18 patients receiving this new device in three different centers, and achieved procedural success in 16 (89%). Failed procedures involved right ventricle perforation that required surgery, or device dislocation.

 

At one year, there were no deaths, significant arrhythmia, device infection or device dislocation. In all 14 patients with successful implantation at one year follow up, there was significant functional class improvement and an 84 meter increase in the 6 minute walk test.


Also Read: VIVA post-market study: More Evidence for the “Valve-in-Valve Technique”.


The echocardiogram showed a reduction of prior-procedure severe tricuspid regurgitation to moderate or less in 69% of patients at 30 days and in 46% of patients at one year. Tricuspid annulus and right ventricle diameter also saw a reduction at one year (from 45.7 ± 4.8 mm to 42.1 ± 4.4 mm, p=0.004 and from 54 ± 5.3 mm to 49.9 ± 4.3 mm, p=0.02, respectively).

 

Conclusion

 

FORMA device implantation in high risk patients with severe tricuspid regurgitation is feasible and has shown good safety outcomes at mid-term. At one year, despite variable reduction in tricuspid regurgitation grade, there was significant clinical improvement and ventricular diameter reduction.

 

Editorial Comment

 

The main contribution of this study is the significant clinical improvement driven by tricuspid regurgitation reduction and diameter improvement at one year. This favorable trend lead to shorter hospitalization periods for cardiac failure. Improvement can be standardized by reducing right atrial filling pressure and increasing right ventricle demand.  

 

The most modest echocardiograms did not correlate with the clinical or hemodynamic outcomes, which could be due to the measuring techniques used once the device was in place.

 

Original Title: Transcatheter Tricuspid Valve Repair with a New Transcatheter Coaptation System for the Treatment of Severe Tricuspid Regurgitation. 1-Year Clinical and Echocardiographic Results.

Reference: Gidon Perlman et al. J Am Coll Cardiol Intv 2017. Article in press.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

 

More articles by this author

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...

TAVI and Hypertrophic Cardiomyopathy: An Increasingly Common Association

Stenosis is a common disease affecting 5% of the elderly population. It is associated with hospitalizations, poor quality of life, and mortality.  The association between...

TAVR in Bicuspid Valves: Higher Prosthesis Mismatch?

TAVR indication is steadily advancing onto younger, lower risk patients.  The presence of bicuspid aortic valves (BAV) has been observed in 0.5% to 2% of...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

Intravascular Lithotripsy in Calcified Coronary Lesions: Success Predictors

Coronary artery calcification (CAC) is increasingly common in patients undergoing percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has been established as an effective tool...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...