Valve-in-Valve Implantation for Early Failure of a Transcatheter Tricuspid Valve

Transcatheter tricuspid valve replacement (TTVR) is increasingly used for severe tricuspid regurgitation in high-risk patients. Early prosthetic dysfunction may occur, but management strategies remain poorly described.

A 79-year-old woman presented with cardiogenic shock 6 months after Topaz TTVR. Echocardiography and computed tomography showed leaflet thickening involving 2 of 3 leaflets with a mean gradient of 9 mm Hg. Endocarditis was excluded, and anticoagulation optimization failed. Because of persistent catecholamine dependence and prohibitive surgical risk, the heart team selected transcatheter valve-in-valve implantation. Bench testing using a computed tomography-derived 3-dimensional printed model guided a 29-mm Sapien 3 valve implantation, reducing the gradient to 1 mm Hg with no residual regurgitation.

Valve-in-valve implantation may be an effective rescue strategy after failed TTVR. Patient-specific bench testing improves procedural planning and procedural safety.

Early dysfunction of TTVR prostheses requires prompt multimodality evaluation. Bench-guided transcatheter valve-in-valve implantation can safely avoid high-risk redo surgery.