Transcatheter Tricuspid Valve in valve

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

More articles by this author

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

TCT 2024 | TRISCEND II: A New Hope in Percutaneous Tricuspid Valve Replacement

Advanced tricuspid regurgitation (TR) is a debilitating disease associated with heart failure and increased mortality.  Edge-to-edge repair has been shown to improve both clinical condition...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....