Intermediate term hemodynamic effects of single inferior vena cava valve implant for the treatment of severe tricuspid regurgitation

Abstract

Severe tricuspid regurgitation (TR) remains a vastly undertreated disease, with sustained elevation of right atrial (RA) pressure directly resulting in chronic end-organ damage. Recently, bi-caval valve implantation has been shown to improve symptoms in patients with symptomatic TR who are at high risk for surgery. We present the first report of intermediate term hemodynamic effects of single inferior vena cava (IVC) valve implantation (CAVI) for treatment of severe TR. We performed CAVI on a 66-year-old female with severe TR, who suffered from repeat hospitalizations for treatment refractory NYHA class III-IV heart failure symptoms and had prohibitive operative risk. Pre-implantation right heart catheterization (RHC) revealed a mean RA pressure of 12 mm Hg, an IVC mean pressure of 13 mm Hg, with V-waves to 16 and 18 mm Hg in the RA and IVC respectively, and a cardiac output (CO) of 3.5 liters per minute (LPM). Postprocedure, mean IVC and RA pressures decreased to 11 and 10 mm Hg, respectively, with CO increasing to 5.1 LPM. At one month, symptoms improved to NYHA class II. At 9 months, mean RA pressure was 5 mm Hg with V-waves to 7 mm Hg and an improvement in CO to 6.3 LPM. CAVI appears to result in similar decreases in RA pressure at intermediate follow-up as compared to bi-caval valve implantation. The favorable hemodynamic effects were likely mediated by redirection of regurgitant blood flow away from the IVC thereby resulting in sustained reduction in right-sided pressures as well as an increase in CO. © 2017 Wiley Periodicals, Inc.

Monitoring of mitral‐ and tricuspid valve interventions with CardioMEMS: Insights beyond imaging

“…8 Some data also indicate improvement of RV function and CO in to a reduction of TR. [25][26][27] In our patient, CO increased, and PA pressures decreased, which was not measurable on echo or clinical indices (Table 2).…”

Transcatheter heterotopic valve implantation with the TricValve system: focus on preoperative assessment and patient selection

“…Despite being the first successful transcatheter tricuspid valve option, hemodynamic concerns following CAVI must be better evaluated in the long term 28–30 . Although heterotopic CAVI appears to offer potential benefits to patients with tricuspid valve regurgitation who are unsuitable for cardiac surgery, there are still hemodynamic concerns following CAVI that may be addressed, such as persistent RA overload, RA ventricularization, and the effect of an increased RV preload on the right chamber.…”

Heterotopic caval valve implantation in severe tricuspid regurgitation

“…Despite being the first successful transcatheter tricuspid valve therapy used in humans, hemodynamic concerns following CAVI, including the long-term impact of RA ventricularization, persistent RA volume overload, and increased RV afterload, have perhaps prevented the broader use of CAVI for treating TR. [ 4 8 9 ] Future studies will need to evaluate long-term outcomes of this therapy. The role of bicaval implantation versus IVC implant only will also have to be assessed.…”