Percutaneous Tricuspid Valve Replacement Studied in Congenital and Acquired Heart Disease Patients

June 28, 2011—In the Journal of the American College of Cardiology, Philips A. Roberts, MBChB, et al published findings from a study that sought to describe the first human series of percutaneous tricuspid valve replacements in patients with congenital or acquired tricuspid valve (TV) disease (2011;58:117–122). The investigators concluded that in selected cases patients with previous TV surgery may be candidates for percutaneous TV replacement.

The investigators noted that percutaneous transcatheter heart valve replacement of the ventriculoarterial (aortic, pulmonary) valves is an established procedure. Although there are isolated reports of transcatheter atrioventricular heart valve replacement (hybrid and percutaneous), this procedure has been less frequently described. The investigators stated that they are not aware of any series describing this procedure for TV disease.

As detailed in the Journal of the American College of Cardiology, the investigators approached institutions with significant experience with the Melody percutaneous pulmonary valve (Medtronic, Inc., Minneapolis, MN) to collect data where this valve had been implanted in the tricuspid position. Clinical and procedural data were gathered for 15 patients. Indications for intervention included severe hemodynamic compromise and perceived high surgical risk. All patients had previous TV surgery and significant stenosis and/or regurgitation of a bioprosthetic TV or a right atrium–to–right ventricle conduit.

The investigators reported that procedural success was achieved in all 15 patients. In patients with predominant stenosis, the mean tricuspid gradient was reduced from 12.9 to 3.9 mm Hg (P < .01). In all patients, tricuspid regurgitation was reduced to mild or none. New York Heart Association functional class improved in 12 patients. The only major procedural complication was of third-degree heart block requiring pacemaker insertion in one patient. One patient developed endocarditis at 2 months after the implant procedure, and one patient with preprocedural multiorgan failure did not improve and died 20 days after the procedure. The remaining patients have well-functioning Melody valves in the TV position at a median of 4 months after implantation, stated the investigators.