Key result
CAVI improves hemodynamics and symptoms in 2 patients with severe refractory TR.
Why the study?
Severe tricuspid regurgitation is difficult to treat medically and often surgical intervention is contraindicated due to high morbidity and mortality.
Does heterotopic caval valve implantation improve haemodynamics and symptoms in patients with severe tricuspid regurgitation refractory to medical therapy who are unsuitable for surgery?
Case Report (n=2)
Does heterotopic caval valve implantation improve haemodynamics and symptoms in patients with severe tricuspid regurgitation refractory to medical therapy who are unsuitable for surgery?
Heterotopic caval valve implantation may be a viable option for symptom relief and haemodynamic improvement in patients with severe tricuspid regurgitation who are refractory to medical therapy and unsuitable for surgery.
CAVI may relieve symptoms in refractory severe TR; leaves open need for prospective trials before clinical adoption.
BACKGROUND: Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. CASE SUMMARY: We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient's surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. DISCUSSION: Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.
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Sharkey et al. (2020) conducted a case report in Severe tricuspid regurgitation (n=2). Heterotopic caval valve implantation (CAVI) was evaluated on Postoperative haemodynamics and symptom improvement. Heterotopic caval valve implantation successfully improved postoperative hemodynamics and symptoms in 2 patients with severe tricuspid regurgitation refractory to medical therapy.
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