Outcomes of Tricuspid Valve in Valve Implantation Via Trans-jugular and Transfemoral Approach

Abstract

Introduction: Transcatheter “Valve-in-valve” (VIV) implantation for degenerated surgical bioprostheses has been described as a viable therapeutic option. We highlight our experience treating failed surgical bioprostheses in the tricuspid position utilising the Edwards SAPIEN 3 valve which poses unique clinical and technical challenges. Objective: Demonstrate the feasibility and effectiveness of tricuspid VIV implantation. Methods: Four patients underwent VIV implantation. Underlying diagnoses were: Ebstein anomaly n = 2, Carcinoid syndrome n = 1 and previously replaced native valve for infective endocarditis n = 1. Previous valve type and size was: Biocor (St Jude Medical), n = 2 (27 mm, 33 mm), Perimount n = 1 (29 mm) and Medtronic Intact n = 1 (33 mm). Valve dysfunction was regurgitation in 3 and stenosis in 1. Procedural access was via the femoral vein in 3 and jugular vein in 1. Edwards Sapien S3 valves (29 mm n = 3 and 26 mm n = 1) were deployed and all procedures were successful and uncomplicated. Results: None or trivial residual tricuspid regurgitation was present in all cases and median post procedural tricuspid valve mean gradient was 4mmHg (range 2-5). Median follow-up was 13.5 months (range 2-17) and median gradient was 6mmHg. One patient has developed progressive severe stenosis (MG 14mmHg) despite anticoagulation. Conclusion: All four patients underwent successful tricuspid VIV implantation for severely degenerated (regurgitant or stenotic) tricuspid surgical bioprostheses. Both the transjugular and femoral approach may be used successfully, with unique clinical advantages for each depending on the surgical valve orientation. Tricuspid VIV implantation is clinically feasible with excellent acute haemodynamic outcomes and safety.