First-in-human transcatheter pledget-assisted suture tricuspid annuloplasty for severe tricuspid insufficiency
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Published on: February 11, 2022
Adam B Greenbaum1,2, Jaffar M Khan3,4, Toby Rogers3,4
1Divisions of Cardiology and Cardiac Surgery, Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA.
Objectives:
We report the first pledget-assisted suture tricuspid annuloplasty (PASTA) in a patient with torrential tricuspid regurgitation (TR).
Background:
Tricuspid valve regurgitation is a common malignant disease with no commercially available transcatheter therapy. PASTA is a "percutaneous surgical" procedure using pledgeted sutures to create a double-orifice tricuspid valve.
Methods:
An 83-year-old man had end-stage TR caused by a defibrillator lead. He consented to undergo PASTA on a compassionate basis. A double-orifice valve was created with pledgeted sutures from percutaneous right ventricular apical access.
Results:
TR was reduced from torrential to trace. The vena contracta reduced to from 23 to 1 mm and annular area reduced from 1817 to 782 mm2 . However, the annulus dehisced and required closure with a percutaneous nitinol plug. The patient was discharged home and was alive 6 months later but with persistent symptoms.
Conclusions:
The anatomy of a double-orifice valve can eliminate TR but a better solution is required to avoid excessive suture tension on annular tissue.
