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Percutaneous tricuspid valve replacement in congenital and acquired heart disease

Philip A Roberts1, Younes Boudjemline, John P Cheatham

  • 1Royal Prince Alfred Hospital, Sydney, Australia. philipr2@chw.edu.au

Journal of the American College of Cardiology
|July 2, 2011
PubMed

Insights

This study shows percutaneous tricuspid valve replacement using the Melody valve is a safe and effective option for patients with severe tricuspid valve disease who are at high surgical risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter heart valve replacement is established for aortic and pulmonary valves.
  • Transcatheter atrioventricular valve replacement is less common, with no series for tricuspid valve disease.
  • Tricuspid valve disease often requires intervention in patients with prior cardiac surgery.

Purpose of the Study:

  • To describe the first human series of percutaneous tricuspid valve replacements.
  • To evaluate the safety and efficacy of the Melody valve in the tricuspid position.
  • To assess outcomes in patients with congenital or acquired tricuspid valve disease.

Main Methods:

  • Retrospective data collection from institutions experienced with the Melody valve.
  • Analysis of clinical and procedural data for 15 patients undergoing percutaneous tricuspid valve replacement.
  • Inclusion criteria: severe hemodynamic compromise, high surgical risk, prior tricuspid valve surgery, and significant stenosis/regurgitation.

Main Results:

  • 100% procedural success in all 15 patients.
  • Significant reduction in mean tricuspid gradient (12.9 to 3.9 mm Hg) for stenosis.
  • Tricuspid regurgitation reduced to mild or none; 12 patients improved in functional class.
  • Low complication rate: one heart block, one endocarditis; one mortality in a patient with multiorgan failure.

Conclusions:

  • Percutaneous tricuspid valve replacement is feasible in selected high-risk patients.
  • The Melody valve can be effectively used for tricuspid valve replacement in patients with prior surgery.
  • This approach offers a viable alternative for complex tricuspid valve disease.
Abstract

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