Abstract
Tricuspid valve-in-valve (VIV) implantation has recently emerged as a possible therapeutic option when a bioprosthetic valve degenerates. A French retrospective study is reported. From 2010 to end 2014, 9 patients underwent tricuspid VIV implantation. There were 4 females and 5 males. Pts were in functional NYHA class III. Seven pts had congenital heart disease, 1 pt a rheumatic disease, 1 pt a cardiomyopathy. Causes for implantation were tricuspid stenosis (n = 4), a mixed lesion combining tricuspid stenosis and regurgitation (n = 4), and one tricuspid regurgitation. In addition, 2 of them suffered from protein losing enteropathy (PLE). Implantation was performed under general anaesthesia using a femoral approach at a mean age of 29.5±18 years (9-60 years). Two pts underwent pre-dilatation of the lesion and a pre-stenting was performed in 6. VIV implantation was realized under pacing in 3 pts. A 22-mm Melody valve (Medtronic) was implanted in 6 pts, and an Edwards Sapien valve in 3 (one 23-mm, one 26mm, and one 29-mm valve). Implantation succeeded in all despite 2 embolizations (1 in RA and 1 in RV); the embolized stent could be stabilized within the tricuspid annulus in both by a self-expandable stent before subsequent successful VIV implantation using a second valved stent. During follow-up (mean 10 months and up to 24 months), all pts but one were clinically ameliorated (mean functional NYHA class II) including the 2 pts with PLE (increase in albumin level). The mean tricuspid gradient decreased significantly from 9.4±2.3 mm Hg before to 3.9±0.4 mm Hg after implantation. Two pts died during follow-up but death was not valved stent related. To conclude, tricuspid VIV implantation is an effective procedure using both the Melody and the Edwards Sapien valves. Knowledge of the true minimal diameter is the key point to choose the appropriate valved stent. This promising technique has good immediate and mid-term results but further studies with longer follow-up and including more pts are necessary
Published Version
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