Transcatheter tricuspid valve-in-valve implantation with bioprosthetic balloon expandable valve

• Published in: General thoracic and cardiovascular surgery Vol. 70; no. 11; pp. 947 - 953
• Main Authors: Haji-Zeinali, Ali-Mohammad, Etesamifard, Nasrin, Mohammadi, Zohre, Haji-Zeinali, Mohammad-Mohsen, Sahebjam, Mohammad, Abbasi, Kiomars
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-11-2022; Springer Nature B.V
• Subjects: Cardiac Surgery; Cardiology; General anesthesia; Heart; Medical imaging; Medicine; Medicine & Public Health; Original Article; Pacemakers; Patients; Prostheses; Pulmonary arteries; Surgery; Surgical Oncology; Thoracic Surgery; Veins & arteries; Iran; Transcatheter tricuspid valve in valve; Tricuspid valve disease; Balloon expandable valve; Bioprosthetic valve
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-022-01829-z

Objectives
This study was conducted to evaluate the outcome of the transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves with transcatheter aortic valves.
Methods
This retrospective study enrolled all consecutive patients who were considered high risk for reoperations by the heart team and who underwent transcatheter valve-in-valve implantation for degenerated tricuspid bioprosthetic valves in Tehran Heart Center, Tehran, Iran. All the procedures were performed via the transfemoral venous route under echocardiography and fluoroscopy guidance with Edwards SAPIEN transcatheter heart valves (Edwards Lifesciences, Irvine, CA).
Results
Ten patients underwent successful transcatheter valve-in-valve implantation in the tricuspid position without any major complications or need for emergency surgical interventions. The mean age was 54.1 ± 17.1 years, and 8 patients were female. The median follow-up was 19.5 months (16–32.25 mon). The mean period between the last tricuspid valve replacement and transcatheter valve-in-valve implantation was 4.9 ± 2.2 years. The bioprosthetic valves were Hancock in three patients, Mosaic in the other three patients, and Biocor, Pericarbon, Perimount, and Epic in the other patients. After the procedure, the clinical and functional status improved significantly in all the patients. The mean transvalvular gradient decreased from 6.75 ± 2.66 mm Hg to 2.85 ± 0.89 (
P
 < 0.001), and the postoperative tricuspid regurgitation severity decreased significantly in almost all the patients. The hospitalization period after the procedure was 4.4 ± 1.7 days.
Conclusions
In high-risk patients, transcatheter valve-in-valve implantation seems to be a safe and minimally invasive alternative to reoperations for degenerated tricuspid bioprosthetic valves.