Percutaneous Tricuspid Valve Implantation

Abstract

Background-Severe tricuspid valve (TV) dysfunction may lead to surgical TV replacement with a biological valve prosthesis in patients with congenital heart disease. To expand the lifetime of this valve and reduce the number of surgeries, percutaneous TV implantation (PTVI) may be an effective alternative to repeated surgery. We report on our 2-center experience with PTVI. Methods and Results-Between 2008 and 2014, 17 percutaneous valves were implanted in 16 patients with TV bioprosthesis dysfunction (9 females) from 2 centers. Median age and weight were 31.3 years (5-77.2) and 65.2 kg (17.7-107); 14 patients had congenital heart disease (univentricular heart with a right atrial to right ventricle bioprosthesis in 3, Ebstein's anomaly of the TV in 5, and other in 6), and 2 had acquired TV dysfunction. All procedures were successful (Melody n=7, Sapien 26 mm valve n=4, Sapien XT 29 mm valve n=6). One valve showed early dysfunction. It was replaced surgically and shortly after that a repeated PTVI was performed. The median duration of follow-up was 2.1 years (3 days to 6.3 years). The percutaneous valve was performing well in 15 of 16 patients. Conclusions-PTVI was safe and effectively improved TV function in all but 1 patient at midterm follow-up. We think that PTVI is a good alternative to repeated surgical TV replacements and that it may reduce the total number of open heart surgeries in these patients. (Circ Cardiovasc Interv. 2015;8:e002155.

Current Interventional and Surgical Management of Congenital Heart Disease

“…In the younger population, most have been performed in the setting of prior bioprosthetic valve replacement secondary to prosthesis deterioration. [48][49][50] The advantage is a safe, solid landing zone with low probability of adjacent coronary compromise. The importance of slightly oversizing the stented bioprosthesis at the time of surgical implantation cannot be overemphasized to facilitate future valve-in-valve therapies, which can be more than once if there is enough space in the original surgically placed bioprosthesis.…”

Surgical management of tricuspid stenosis

“…Most patients in this study had congenital abnormalities requiring TVR during childhood. Results were favorable, with the percutaneous valve functioning well in 15 out of 16 patients at 2 years follow-up (12). Both studies involved collaboration between interventional cardiologists and cardiac surgeons, and as the technology improves, we only expect the use of percutaneous valves to increase.…”

Pediatric Transcatheter Valve Replacement

“…There has been, to date, no lack of creative off-label use of existing valves to palliate children with congenital heart disease. [21][22][23] Such reports of first-in-man may be individually significant, but hold little prospect for advancing meaningful device development.…”