Jamil Aboulhosn1, Allison K Cabalka2, Daniel S Levi3, Dominique Himbert4, Luca Testa5, Azeem Latib6, Raj R Makkar7, Younes Boudjemline8, Dennis W Kim9, Joelle Kefer10, Sabine Bleiziffer11, Gunter Kerst12, Danny Dvir13, Doff B McElhinney14. 1. Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. Electronic address: jaboulhosn@mednet.ucla.edu. 2. Mayo Clinic, Rochester, Minnesota. 3. Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. 4. Bichat Hospital, Paris, France. 5. Department of Cardiology, IRCCS Pol. S. Donato, Milan, Italy. 6. EMO-GVM Centro Cuore Columbus & San Raffaele Hospital, Milan, Italy. 7. Cedars-Sinai Medical Center, Los Angeles, California. 8. Necker Enfants Malades Hospital, Paris, France. 9. Emory University, Atlanta, Georgia. 10. Cliniques Universitaires Saint-Luc, Brussels, Belgium. 11. German Heart Center, Munich, Germany. 12. University Hospital of Giessen, Giessen, Germany. 13. St. Paul's Hospital, Vancouver, Canada. 14. Stanford University, Palo Alto, California.
Abstract
OBJECTIVES: This study sought to describe the results of transcatheter tricuspid valve-in-ring (TVIR) implantation for treatment of tricuspid regurgitation (TR). BACKGROUND: Off-label use of transcatheter valves within surgically placed tricuspid annuloplasty prostheses has only been described in small reports. An international multicenter registry was developed to collect data on TVIR implantation. METHODS: Data were collected from 13 sites on 22 patients (5 to 69 years of age) with TR who underwent catheterization with the intent to perform TVIR implantation. RESULTS: TVIR implantation was performed in 20 patients (91%). Most patients were severely impaired (86% in New York Heart Association functional class III or IV); TR was severe in 86%. A Sapien valve (Edwards Lifesciences, Irvine, California) was implanted in 17 patients and a Melody valve (Medtronic, Minneapolis, Minnesota) in 3. There were no procedural deaths. There was 1 valve embolization requiring retrieval and placement of second TVIR implant and 1 valve malposition with severe paravalvular regurgitation requiring a second TVIR implantation. Over a median follow-up of 12 months, 1 patient died and 2 underwent repeat TVIR implantation, 1 of whom subsequently underwent surgical valve replacement. Significant paravalvular leak (PVL) was treated at the time of TVIR implantation in 4 patients: 3 underwent device occlusion and 1 received a second TVIR implant. On follow-up echocardiography, 15 patients had PVL (75%), the majority of which (n = 10) were trivial or mild and did not require treatment. PVL intervention was performed in 3 patients during follow-up. Functional capacity improved in most patients (70%). CONCLUSIONS: TVIR implantation using commercially available transcatheter prostheses is technically feasible and clinically effective in reducing TR. Paravalvular regurgitation is common and may necessitate further interventions.
OBJECTIVES: This study sought to describe the results of transcatheter tricuspid valve-in-ring (TVIR) implantation for treatment of tricuspid regurgitation (TR). BACKGROUND: Off-label use of transcatheter valves within surgically placed tricuspid annuloplasty prostheses has only been described in small reports. An international multicenter registry was developed to collect data on TVIR implantation. METHODS: Data were collected from 13 sites on 22 patients (5 to 69 years of age) with TR who underwent catheterization with the intent to perform TVIR implantation. RESULTS: TVIR implantation was performed in 20 patients (91%). Most patients were severely impaired (86% in New York Heart Association functional class III or IV); TR was severe in 86%. A Sapien valve (Edwards Lifesciences, Irvine, California) was implanted in 17 patients and a Melody valve (Medtronic, Minneapolis, Minnesota) in 3. There were no procedural deaths. There was 1 valve embolization requiring retrieval and placement of second TVIR implant and 1 valve malposition with severe paravalvular regurgitation requiring a second TVIR implantation. Over a median follow-up of 12 months, 1 patient died and 2 underwent repeat TVIR implantation, 1 of whom subsequently underwent surgical valve replacement. Significant paravalvular leak (PVL) was treated at the time of TVIR implantation in 4 patients: 3 underwent device occlusion and 1 received a second TVIR implant. On follow-up echocardiography, 15 patients had PVL (75%), the majority of which (n = 10) were trivial or mild and did not require treatment. PVL intervention was performed in 3 patients during follow-up. Functional capacity improved in most patients (70%). CONCLUSIONS: TVIR implantation using commercially available transcatheter prostheses is technically feasible and clinically effective in reducing TR. Paravalvular regurgitation is common and may necessitate further interventions.
Authors: Benjamin S Wessler; Christine M Lundquist; Benjamin Koethe; Jinny G Park; Kristen Brown; Tatum Williamson; Muhammad Ajlan; Zuhair Natto; Jennifer S Lutz; Jessica K Paulus; David M Kent Journal: J Am Heart Assoc Date: 2019-10-04 Impact factor: 5.501
Authors: Philipp Lake; Elmar W Kuhn; Victor Mauri; Sascha Macherey; Julia Kaliba; Stephan Baldus; Christian Frerker; Tobias Schmidt Journal: Clin Res Cardiol Date: 2021-04-28 Impact factor: 5.460