Transcatheter tricuspid valve-in-valve implantation was successful in 150 of 152 attempts, with 77% of patients achieving NYHA class I or II at follow-up (P<0.001 vs baseline).
Observational (n=156)
Yes
Does transcatheter tricuspid valve-in-valve implantation improve clinical and hemodynamic outcomes in patients with dysfunctional surgical tricuspid valve bioprostheses?
Transcatheter tricuspid valve-in-valve implantation is a technically and clinically successful option for treating dysfunctional surgical tricuspid bioprostheses, leading to significant symptomatic and hemodynamic improvements.
p-value: p=<0.001
BACKGROUND: 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. 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 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. CONCLUSIONS: 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.
McElhinney et al. (Sat,) conducted a observational in Dysfunctional surgical tricuspid valve bioprostheses (n=156). Transcatheter tricuspid valve-in-valve implantation was evaluated on NYHA class I or II at follow-up (p=<0.001). Transcatheter tricuspid valve-in-valve implantation was successful in 150 of 152 attempts, with 77% of patients achieving NYHA class I or II at follow-up (P<0.001 vs baseline).
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