Transcatheter Tricuspid Valve-in-Valve Implantation for the Treatment of Dysfunctional Surgical Bioprosthetic Valves: An International Multicenter Registry Study
Background—Off-label use of transcatheter aortic and pulmonary valve prostheses for tricuspid valve-in-valve (TVIV) implantation within dysfunctional surgical tricuspid valve (TV) bioprostheses has been described in small reports.
Methods and Results—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 NYHA 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, the TV inflow gradient and TR grade both improved significantly. During follow-up (median 13.3 months), 22 patients died, 5 within 30 days; all 22 patients were in NYHA class III or IV and 9 were hospitalized prior to TVIV. There were 10 TV reinterventions and 3 other patients with significant recurrent TV dysfunction. At follow-up, 77% of patients were in NYHA class I or II (p<0.001 vs pre-TVIV). Outcomes did not differ according to surgical valve size or TVIV valve type.
Conclusions—TVIV using commercially available transcatheter prostheses is technically and clinically successful in patients of varying age across a wide range of valve size. Although pre-implant clinical status was associated with outcome, many patients in NYHA class III or IV at baseline improved. TVIV should be considered a viable option for treatment of failing TV bioprostheses.
- Ebstein's anomaly
- rheumatic heart disease
- percutaneous valve
- transcatheter valve implantation
- Received September 4, 2015.
- Revision received January 15, 2016.
- Accepted February 19, 2016.