Transcatheter Tricuspid Valve Replacement for Surgical Failures

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Tricuspid valve surgery carries significant mortality risks, especially for repeat procedures.
• Failed surgical prostheses and repairs necessitate alternative treatment options.

Purpose of the Study:

• To explore transcatheter tricuspid valve replacement (TTVR) as a viable solution for patients with failed tricuspid valve interventions.
• To discuss the nuances and challenges associated with TTVR, including valve-in-valve and valve-in-ring procedures.

Main Methods:

• Utilizing balloon-expandable bioprosthetic valves in an off-label manner for tricuspid valve-in-valve (TViV) procedures.
• Analyzing the complexities of valve-in-ring cases, including risks of paravalvular leak and valve malpositioning.

Main Results:

• TViV procedures using off-label valves can be performed reliably.
• Valve-in-ring TTVR cases are more complex, with increased risks of paravalvular leak and malpositioning.

Conclusions:

• TTVR is a tangible solution for failed tricuspid valve surgeries, particularly TViV.
• Careful consideration of specific challenges like THV anchoring, pacing leads, and thromboembolic prophylaxis is crucial for successful TTVR outcomes.