P48 PATIENT SELECTION FOR TRANSCATHETER TRICUSPID ANNULOPLASTY: CASE PRESENTATION

Abstract

Abstract Clinical case We describe the case of an 87–year–old woman, BSA 1.7 m2, affected by arterial hypertension, atrial fibrillation, COPD, stage III chronic renal failure. The patient underwent aortic valve replacement with a biological prosthesis. The patient had good quality of life. n the last year, the patient had had two hospitalizations for right heart failure, with a home dose of Furosemide of 250 mg/day. A transthoracic echocardiogram, performed in outpatient setting, showed massive tricuspid regurgitation (ERO 0.8 cm2), TAPSE 21 mm, S TDI 0.12 cmc/sec, LVEF 55%, sPAP 40 mmHg (RHC). The TRISCORE (specific risk score for tricuspid pathology) was equal to 8%, therefore at a high preoperative risk. The case was collectively discussed in the Heart Team and we decided for transcatheter treatment of the isolated tricuspid pathology. A transesophageal echocardiogram confirmed the severity of the tricuspid regurgitation, characterized by multiple jets of which the prevalent central and posteroseptal. The coaptation gap was 10 mm, with partial retraction of the septal flap. Therefore, the possibility of an edge–to–edge treatment was excluded and the screening for annuloplasty device evaluation (Cardioband) continued. Cardio–CT showed feasibility for Cardioband with adequate implant safety and distance from the right coronary artery. Therefore, a Cardioband (Edwards Lifesciences) was implanted in the tricuspid position. The procedural time was 220 minutes. The final result was tricuspid regurgitation less than grade 2 (R vol 30 mL/beat, EROA 0.2). The patient was discharged on the 4th postoperative day. At the 30–day follow–up, he was in NYHA class I–II, with a furosemide dose of 75 mg/day, in the absence of peripheral edema. Conclusions Patients with isolated tricuspid regurgitation are, in most cases, not treated due to the high postoperative surgical risk. In recent years, transcatheter technologies have been a valid solution in the event of inoperability. Where a treatment on the valve leaflets is not feasible, tricuspid annuloplasty represents a valid alternative.