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

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...