Transfemoral implantation of Edwards SAPIEN-XT® transcatheter heart valve in a degenerated tricuspid bioprosthesis.

We report on a percutaneous transcatheter valve-in-valve implantation (Edwards-SAPIEN-XT®) (Edwards Lifesciences Corp., One Edwards Way Irvine, CA 92614) in a 50-year-old i.v. drug user with a history of biological tricuspid valve replacement (Perimount 31 mm) (Edwards Lifesciences Corp., One Edwards Way Irvine, CA 92614) due to tricuspid valve endocarditis five years earlier. Re-operation was considered unfavorable due to general and specific risk factors. The case was discussed by the heart team. Obviously, some type of valve replacement was required. Given the high risk of tricuspid valve re-operation in general and the specific risk factors of the patient (New York Heart Association functional class III, reduced right ventricular function, continued drug abuse, active hepatitis C and human immunodeficiency virus infection, suspected non-compliance, unfavorable social background) the consensus was to attempt percutaneous transcatheter valve-in-valve implantation. Implantation of an Edwards-SAPIEN-XT® valve (Edwards Lifesciences Corp., One Edwards Way Irvine, CA 92614) in tricuspid position was successfully performed and the patient was transferred to the ward on day 2, completely free of symptoms. Pre-discharge echocadiographic control on day 6 again confirmed adequate position and regular function of the Edwards-SAPIEN-XT® valve (Edwards Lifesciences Corp., One Edwards Way Irvine, CA 92614) without any signs of regurgitation or stenosis. <Learning objective: Transcatheter valve-in-valve implantation in tricuspid position is feasible and offers a valuable therapeutic alternative in selected patients. Despite encouraging initial experience with transcatheter valve implantation in native or prosthetic tricuspid valves, further studies are needed to establish the clinical value of this technique.>.