Key result
Tricuspid valve-in-valve implantation cuts mean gradient to ~4 mm Hg with sustained 1-year symptom relief.
Why the study?
Bioprosthetic tricuspid valves deteriorate over time and repeat surgery carries prohibitive risk in patients with multiple prior sternotomies and comorbidities, prompting consideration of transcatheter alternatives.
Does percutaneous tricuspid valve-in-valve implantation safely improve hemodynamics and symptoms in a patient with severe bioprosthetic tricuspid stenosis at prohibitive surgical risk?
Case Report (n=1)
No
Does percutaneous tricuspid valve-in-valve implantation safely improve hemodynamics and symptoms in a patient with severe bioprosthetic tricuspid stenosis at prohibitive surgical risk?
Percutaneous tricuspid valve-in-valve implantation is a technically feasible and effective option for relieving right heart failure symptoms in patients with failed bioprostheses at prohibitive risk for redo surgery.
May offer percutaneous relief for prohibitive-risk tricuspid stenosis; extends case experience but leaves open prospective validation.
BACKGROUND: Bioprosthetic tricuspid valves are prone to structural deterioration over time. In patients with multiple prior sternotomies and functioning left-sided prostheses, repeat surgery may carry prohibitive risk, prompting consideration of transcatheter alternatives. CASE SUMMARY: A 42-year-old patient with rheumatic heart disease and a history of 3 prior sternotomies for mitral, aortic, and tricuspid valve replacement presented with recurrent admissions for diuretic-resistant right heart failure complicated by congestive hepatopathy (Child-Pugh B cirrhosis). Imaging demonstrated severe stenosis of a bioprosthetic tricuspid valve, with preserved left-sided valve function. The patient underwent successful percutaneous tricuspid valve-in-valve implantation, resulting in marked symptomatic improvement and significant reduction in transvalvular gradients on echocardiography. DISCUSSION: Current guidelines support reintervention for symptomatic bioprosthetic valve dysfunction. In high surgical risk patients, percutaneous tricuspid valve-in-valve implantation represents an effective and less invasive alternative to repeat surgery. TAKE-HOME MESSAGE: Percutaneous tricuspid valve-in-valve replacement is a viable therapeutic option for failed tricuspid bioprostheses in carefully selected high-risk patients.
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Sellers et al. (2026) conducted a case report in Failed bioprosthetic tricuspid valve (severe stenosis) with refractory right heart failure (n=1). Percutaneous tricuspid valve-in-valve implantation was evaluated on Symptomatic relief and transvalvular gradient reduction. Percutaneous tricuspid valve-in-valve implantation successfully reduced the mean transesophageal transvalvular gradient to 3.5 mm Hg and provided sustained relief of right heart failure at 12 months.
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