Transcatheter Tricuspid Valve-in-Valve Implantation for the Treatment of Dysfunctional Surgical Bioprosthetic Valves An International, Multicenter Registry Study

Published on Apr 19, 2016in Circulation23.603
· DOI :10.1161/CIRCULATIONAHA.115.019353
Doff B. McElhinney24
Estimated H-index: 24
(Stanford University),
Allison K. Cabalka30
Estimated H-index: 30
(Mayo Clinic)
+ 27 AuthorsDanny Dvir62
Estimated H-index: 62
(UBC: University of British Columbia)
Off-label use of transcatheter aortic and pulmonary valve prostheses for tricuspid valve-in-valve implantation (TVIV) within dysfunctional surgical tricuspid valve (TV) bioprostheses has been described in small reports.An international, multicenter registry was developed to collect data on TVIV cases. Patient-related factors, procedural details and outcomes, and follow-up data were analyzed. Valve-in-ring or heterotopic TV implantation procedures were not included. Data were collected on 156 patients with bioprosthetic TV dysfunction who underwent catheterization with planned TVIV. The median age was 40 years, and 71% of patients were in New York Heart Association class III or IV. Among 152 patients in whom TVIV was attempted with a Melody (n=94) or Sapien (n=58) valve, implantation was successful in 150, with few serious complications. After TVIV, both the TV inflow gradient and tricuspid regurgitation grade improved significantly. During follow-up (median, 13.3 months), 22 patients died, 5 within 30 days; all 22 patients were in New York Heart Association class III or IV, and 9 were hospitalized before TVIV. There were 10 TV reinterventions, and 3 other patients had significant recurrent TV dysfunction. At follow-up, 77% of patients were in New York Heart Association class I or II (P<0.001 versus before TVIV). Outcomes did not differ according to surgical valve size or TVIV valve type.TVIV with commercially available transcatheter prostheses is technically and clinically successful in patients of various ages across a wide range of valve size. Although preimplantation clinical status was associated with outcome, many patients in New York Heart Association class III or IV at baseline improved. TVIV should be considered a viable option for treatment of failing TV bioprostheses.
📖 Papers frequently viewed together
905 Citations
104 Citations
143 Citations
#1Margarita MalasaH-Index: 4
#2Nikos WernerH-Index: 35
Last. Christoph HammerstinglH-Index: 32
view all 4 authors...
A 60-year-old man was hospitalized with chronic right heart failure, ascites, and peripheral oedema. He had a history of ischaemic cardiomyopathy without need for revascularization, persistent atrial fibrillation, and renal failure. Echocardiography showed moderately reduced left ventricular ejection fraction of 35–40%, without relevant AV or MV disease, severe right heart dilatation, and severe functional tricuspid regurgitation (TR) causing chronic right heart volume overload (PISA 1.5 cm, ERO...
12 CitationsSource
Background Valve-in-valve (ViV) procedures for degenerated bioprostheses are an alternative for the standard of care in an aging population. Several reports showed that the Edwards Sapien XT (Edwards Lifesciences Co., Irvine, California, United States) transcatheter heart valve (THV) can be used in aortic, mitral, and tricuspid position for ViV procedures. No published case series for different valve positions exist regarding suitability of the new Edwards Sapien 3 (Edwards Lifesciences Co.) THV...
9 CitationsSource
#1Alduz S. Cabasa (Mayo Clinic)H-Index: 3
#2Mackram F. Eleid (Mayo Clinic)H-Index: 33
Last. Rakesh M. Suri (Mayo Clinic)H-Index: 63
view all 6 authors...
We describe a percutaneous transcatheter tricuspid valve-in-ring implantation using the Sapien XT prosthesis (Edward Lifesciences, Irvine, California) [(1,2)][1]. A 68-year-old woman with rheumatic heart disease and 2 previous sternotomies including tricuspid valve repair with a 32-mm Carpentier-
23 CitationsSource
9 CitationsSource
#1Azeem LatibH-Index: 73
#2Toru NaganumaH-Index: 24
Last. Antonio Colombo (UniSR: Vita-Salute San Raffaele University)H-Index: 153
view all 23 authors...
Background— Valve thrombosis has yet to be fully evaluated after transcatheter aortic valve implantation. This study aimed to report the prevalence, timing, and treatment of transcatheter heart valve (THV) thrombosis. Methods and Results— THV thrombosis was defined as follows (1) THV dysfunction secondary to thrombosis diagnosed based on response to anticoagulation therapy, imaging modality or histopathology findings, or (2) mobile mass detected on THV suspicious of thrombus, irrespective of dys...
187 CitationsSource
Since the advent of percutaneous valve implantation in the year 2000, many patients were treated successfully by a percutaneously implanted valve in the aortic and less frequently in the pulmonic position. So far, only a few patients were treated by percutaneous tricuspid valve implantation (PTVI) and even less by percutaneous mitral valve implantation. This current chapter describes PTVI. The initial treatment of severe tricuspid valve dysfunction (regurgitation or stenosis or both) is surgical...
29 CitationsSource
#1Shikhar Agarwal (Cleveland Clinic)H-Index: 32
#2E. Murat Tuzcu (Cleveland Clinic)H-Index: 106
Last. Samir R. Kapadia (Cleveland Clinic)H-Index: 88
view all 7 authors...
Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has emerged as an attractive treatment strategy for the treatment of patients with severe symptomatic aortic stenosis (AS), particularly those who are inoperable or at high risk for surgical aortic valve replacement. Several multicentre registries and randomised trials have demonstrated the safety and efficacy of this technology in improving the survival as well as functional capacity of patients with...
44 CitationsSource
Abstract Objectives The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR). Background Very few data exist on PVE after TVR. Methods Studies published between 2000 and 2013 regarding PVE in patients with transcatheter aortic valve replacement (TAVR) or transcatheter pulmonary valve replacement (TPVR) were identified through a systematic electronic search. Results A total ...
61 CitationsSource
#1Pieter De Meester (Katholieke Universiteit Leuven)H-Index: 12
#2Werner Budts (Katholieke Universiteit Leuven)H-Index: 57
Last. Marc Gewillig (Katholieke Universiteit Leuven)H-Index: 76
view all 3 authors...
Although feasibility and efficacy of percutaneous tricuspid valve-in-valve implantation have been established, a transtricuspid pacing or defibrillator lead might preclude this technique: lead damage can cause lead dysfunction resulting in inappropriate or inefficient pacing or shocks. In these cases, lead removal is thought to be the only option. We describe a patient who presented with rapid clinical deterioration due to tricuspid valve stenosis early after implantation of an internal defibril...
6 CitationsSource
#1Aphrodite Tzifa (Boston Children's Hospital)H-Index: 14
#2Tarek S. MomenahH-Index: 4
Last. Shakeel A. QureshiH-Index: 51
view all 6 authors...
Aims: Transcatheter implantation of valved stents (Melody and Edwards valves) for replacement of the pulmonary valve is currently an established procedure. We reviewed our experience on implantation of such valves in the tricuspid valve position. Methods and results: Transcatheter valve implantation in the tricuspid position was attempted in five patients. Four patients had predominantly tricuspid valve regurgitation, two of whom also had tricuspid valve stenosis. All patients had severely sympt...
24 CitationsSource
Cited By109
#1Parth M. Patel (Emory University)H-Index: 3
#2Edward Chiou (Emory University)H-Index: 1
Last. Edward P. Chen (Emory University)H-Index: 31
view all 8 authors...
Abstract Background Clinical outcomes of redo surgical aortic valve replacement (SAVR) compared to Valve-in-Valve Transcatheter Aortic Valve Replacement (VIV-TAVR) are poorly understood. This study compared short and midterm outcomes of patients undergoing isolated redo-SAVR versus VIV-TAVR after previous SAVR. Methods A single-institutional review of the initial use of VIV-TAVR from 2012-2019 identified 273 patients undergoing either VIV-TAVR (n=187) or redo-SAVR (n=86) after prior SAVR. Outcom...
3 CitationsSource
#1Diamantis KosmidisH-Index: 1
#2Ilias NiniosH-Index: 1
Last. Vlasis NiniosH-Index: 11
view all 8 authors...
#1Sashini IddawelaH-Index: 2
#2Prince Josiah Sajanthan Joseph (University of Liverpool)
Last. Amer Harky (Boston Children's Hospital)H-Index: 1
view all 9 authors...
Mitral valve diseases are relatively rare in the paediatric population; however, they can cause considerable mortality and morbidity worldwide. Acquired causes are a major contributor to cardiovascular disease burden in the paediatric population. Diseases can be detected before birth, at birth, or when the child is older and presents with symptoms of advanced heart failure. Definitive management consists of surgical intervention, with mitral valve replacement being the gold standard.Conclusion: ...
#1Alexander M. Spring (Lenox Hill Hospital)H-Index: 1
#2Luigi Pirelli (Lenox Hill Hospital)H-Index: 4
Last. Chad Kliger (Lenox Hill Hospital)H-Index: 13
view all 4 authors...
Abstract Pre-operative multimodality imaging has become an integral part of the planning and execution of transcatheter heart valve procedures. 3D printing of a patient-specific cardiac model is a novel addition to these procedures. This case report discusses the use of pre-operative multimodality imaging, intra-operative fusion imaging, and 3D printing as valuable adjuncts in the planning and simulation of complex structural heart procedures. We describe the case of a 44-year-old woman with pri...
1 CitationsSource
#1Brunilda AlushiH-Index: 8
#2Kourosh VathieH-Index: 1
Last. Alexander LautenH-Index: 30
view all 4 authors...
Moderate-to-severe tricuspid regurgitation (TR) is common and is associated with a poor prognosis. To date, most patients are undertreated; therefore, transcatheter options could be clinically impactful in those who are denied surgery. Several transcatheter solutions have been developed that address the problem via leaflet enhancement, annuloplasty, or heterotopic implantation of self-expandable or balloon-expandable valves in the caval veins. A comprehensive patient evaluation, based on multimo...
1 CitationsSource
#1Tom Kai Ming WangH-Index: 4
#1Tom Kai Ming WangH-Index: 12
Last. Bo XuH-Index: 10
view all 3 authors...
#1Michaela M. Hell (University of Mainz)H-Index: 1
#1Michaela M. Hell (University of Mainz)H-Index: 2
Last. Ralph Stephan von Bardeleben (University of Mainz)H-Index: 23
view all 7 authors...
Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of curren...
2 CitationsSource
#1Varius Dannenberg (Medical University of Vienna)H-Index: 2
#2Carolina Donà (Medical University of Vienna)H-Index: 4
Last. Georg Goliasch (Medical University of Vienna)H-Index: 28
view all 10 authors...
Valve degeneration after surgical tricuspid valve replacement or repair is frequent and may require repeat replacement/repair. For high-risk patients, transcatheter valve-in-valve and valve-in-ring procedures have emerged as valuable treatment alternatives. Preprocedural transthoracic echocardiography is the method of choice to detect malfunction of the prosthesis including degenerative stenosis and/or regurgitation requiring reintervention. Subsequently, computed tomography is helpful for detai...