Salvage Redo TVIR in the Setting of a Malpositioned Transcatheter Heart Valve for Torrential TR

Failure of tricuspid annuloplasty for tricuspid regurgitation (TR) is not uncommon, with transcatheter approaches now used for patients with recurrent TR. A 48-year-old woman with rheumatic mitral valve disease and secondary TR (status post surgical repair) presented with recurrence of severe TR after 6 years. She underwent an attempted tricuspid transcatheter valve-in-ring (TVIR) at an outside institution that was complicated by valve migration and recurrent right-sided heart failure exacerbations. She underwent a redo TVIR procedure at our institution successfully. Both surgical and transcatheter approaches for TR are feasible, depending on patient-specific characteristics. A thorough understanding of normal tricuspid valve anatomy is essential to minimize operative complications and to perform transcatheter interventions successfully. This case supports redo TVIR as a useful alternative to surgery following initial TVIR complications when redo surgery is deemed prohibitive secondary to patient characteristics and a high risk of intraoperative mortality.