Failure of Tricuspid Bioprosthetic Valve After Concomitant Use With a Continuous Flow Temporary Right Heart Pump

Managing right ventricular heart failure (RVHF) is a challenging issue, requiring balancing volume status, increasing right ventricular (RV) contractility, and reducing RV afterload. When RVHF is refractory to medical management, surgical intervention is required. Current studies have documented the success of Impella RP for RVHF. However, there are no reports regarding the concomitant implantation of an Impella RP and a bioprosthetic tricuspid valve. A 79-year-old man presented with a pseudoaneurysm of the left atrioventricular junction. On physical exam he had 4+ diffuse pitting edema and ascites. Transesophageal echo (TEE) confirmed the presence of the pseudoaneurysm while also showing severe right ventricular systolic dysfunction, severe tricuspid regurgitation, dilated right and left atriums, with preserved left ventricular systolic function. Due to the poor function of the right ventricle, it was decided to repair the pseudoaneurysm, replace the tricuspid valve, and place an Impella RP flex. While mechanical circulatory support is an option for patients with RVHF, there is a risk of tricuspid valve damage, particularly in patients who have a concomitant bioprosthetic tricuspid valve replacement. Therefore, other MCS strategies could be more useful in RVHF patients who have a newly implanted bioprosthetic valve.