Transcatheter tricuspid valve-in-valve replacement: Making it simpler

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
Giuliana CaprettiDominique Himbert

Abstract

Transcatheter tricuspid valve-in-valve replacement (TTVR) represents an attractive therapeutic option in very high surgical risk patients with degenerated tricuspid bioprostheses. However, the procedural management of these patients might be challenging due to their comorbidities, long lasting heart valve disease and the presence of left-sided mechanical prostheses. Thus, a more "minimally disruptive" procedure would have several potential benefits in such a frail population. We present the cases of four patients admitted for congestive heart failure due to severe degeneration of their tricuspid bioprostheses who were treated with a minimalist TTVR. The protocol combined continuation of the oral anticoagulant treatment with no bridging therapy, the use of a single venous access with local anesthesia, rapid pacing via the stiff right ventricular wire, and transthoracic echocardiographic guidance and assessment, with no need for contrast injection. Our protocol aims at simplifying the TTVR procedure and might be a useful tool to avoid procedural complications and reduce hospital stay.

References

May 11, 2013·The New England Journal of Medicine·David H BirnieUNKNOWN BRUISE CONTROL Investigators
Mar 7, 2015·Circulation. Cardiovascular Interventions·Claire BouletiAlec Vahanian
Sep 19, 2015·Journal of the American College of Cardiology·Stephen J Rechenmacher, James C Fang
Aug 12, 2016·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Benjamin FaurieJacques Monségu
Feb 1, 2018·Journal of Thrombosis and Thrombolysis·Jessica MarquezAllison E Burnett

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