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

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Degenerated tricuspid bioprostheses pose a significant challenge in high-risk patients.
• Transcatheter tricuspid valve-in-valve replacement (TTVR) is an emerging option, but procedural complexity remains a concern.
• Patients often have multiple comorbidities and may have left-sided mechanical prostheses, complicating management.

Observation:

• A novel minimalist TTVR protocol was applied to four patients with severe tricuspid bioprosthesis degeneration and congestive heart failure.
• The protocol involved continuing oral anticoagulation without bridging, single venous access under local anesthesia, and rapid pacing.
• Transthoracic echocardiography guided the procedure, eliminating the need for contrast injection.

Findings:

• The minimalist TTVR protocol successfully managed patients with degenerated tricuspid bioprostheses.
• This simplified approach facilitated procedural execution in a frail patient population.
• The protocol demonstrated potential for avoiding procedural complications.

Implications:

• The minimalist TTVR protocol offers a potentially safer and more efficient treatment strategy.
• This approach may reduce hospital stay and improve outcomes for high-risk patients.
• Further studies are warranted to validate the long-term efficacy and broader applicability of this simplified TTVR protocol.