William O'Neill, MD, Performs First Transcatheter Triscuspid Valve Replacement in the United States

August 12, 2014—Henry Ford Hospital in Detroit, Michigan, announced that William O’Neill, MD, Medical Director of Henry Ford’s Center for Structural Heart Disease, led a team in performing a transcatheter replacement of a failing tricuspid heart valve for the first time in the United States, and placed it just outside the heart. The procedure was pioneered in Germany. The woman’s tricuspid valve was replaced during a 2-hour procedure on July 31.

Dr. O’Neill, who also performed the first transvascular aortic valve replacement in the United States in 2005, was assisted by Adam Greenbaum, MD, Director of the Cardiac Catheterization Lab at Henry Ford Hospital, and visiting cardiologist Brian O’Neill, MD, who is Assistant Professor of Medicine at the Temple Heart and Vascular Center in Philadelphia, Pennsylvania.

According to Henry Ford hospital, the female patient—a Detroit-area resident—was not a candidate for open surgical valve replacement because of previous medical procedures: one major medical center in the United States turned her down for treatment, and physicians at another hospital advised her that the only option was a heart transplant.

In the hospital’s announcement, Dr. O’Neill commented, “There are a lot of people who have damage of the tricuspid valve, and the surgery is risky, so doctors just try to give them medical therapy. They get a lot of swelling and severe liver congestion. They’re in and out of the hospital, and it really causes a lot of morbidity. So there’s a huge, unmet clinical need. Individuals with this type of valve problem now have another option.”

Dr. O’Neill explained that replacing a tricuspid valve is one of the more difficult heart surgeries because of the valve’s location in the middle of the heart between the right ventricle and the right atrium. Replacement typically requires open-heart surgery. Henry Ford Hospital noted that according to the Society of Thoracic Surgeons, more than 9,100 heart patients undergo tricuspid valve surgery in the United States annually.

The Henry Ford Innovation Institute used 3D modeling to create a working replica of the patient’s heart, which helped the team properly plan the procedure and choose an appropriately sized valve in advance.

In the procedure at Henry Ford Hospital, Dr. O’Neill threaded a used transfemoral approach for the transcatheter insertion of the valve at the junction of the right atrium and the inferior vena cava (IVC). The interventional team first braced the inside of the IVC with a metal, expandable stent and then used the catheter to insert and expand the valve to fit snugly inside. Once deployed, the new valve stopped blood from leaking and pooling in the patient’s abdomen and lower extremities. Doctors monitored pressure through catheters inserted in the IVC above and below the new valve. “There’s already a huge drop in the pressure in the abdomen,” stated Dr. O’Neill. The patient stayed 5 days in the Henry Ford Hospital and was then was released to her home.