Transcatheter Tricuspid Valve Repair | Journal Scan
How feasible is a transcatheter tricuspid valve repair (TTVR)?
An 89-year-old female presented with recurrent right heart decompensation manifesting as severe edema of the lower extremities with skin ulcerations, stage III/IV chronic kidney disease (creatinine = 1.85 ml/dl, glomerular filtration rate = 27 ml/min), and chronic atrial fibrillation. The investigators obtained compassionate use approval for the procedure from the regulatory organization in Germany. To perform the transcatheter bicuspidization of the tricuspid valve, the Mitralign system was used to place pledgeted sutures via a transjugular venous approach. Insulated radiofrequency wires were positioned 2-5 mm from the base of the posterior leaflet, 2.6 cm apart. The sutures were drawn together and locked, thereby plicating the posterior annulus.
Reconstruction of the 3D transesophageal echocardiography (TEE) data set at baseline revealed a tricuspid valve annular area = 14.1 cm2, and effective regurgitant orifice area (EROA) = 1.35 cm2. There was a significant reduction in annular area (57%) and EROA (53%) measured, with 3D TEE, at 6.05 cm2 and 0.63 cm2, respectively. Hemodynamic parameters also improved with a reduction in right atrial pressure from 22 mm Hg at baseline to 9 mm Hg, and an increase in left ventricular stroke volume from 42 cc at baseline to 72 cc.
The authors concluded that TTVR could become an effective treatment for high surgical risk patients with tricuspid regurgitation who are nonresponsive to optimal medical therapy.
This pilot report of a TTVR approach shows potential feasibility and safety of this procedure, as well as a significant reduction in annular area and EROA, resulting in a marked reduction in tricuspid regurgitation. While it is possible that this could become an effective treatment for high surgical risk patients with severe tricuspid regurgitation who are nonresponsive to optimal medical therapy, appropriately designed large prospective studies are needed to objectively assess safety, efficacy, and durability of this procedure.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Atrial Fibrillation, Cardiac Surgical Procedures, Creatinine, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Edema, Glomerular Filtration Rate, Heart Failure, Hemodynamics, Renal Insufficiency, Chronic, Stroke Volume, Tricuspid Valve, Tricuspid Valve Insufficiency, Sutures
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