Transcatheter Tricuspid Valve-in-Valve Implantation for the Treatment of Dysfunctional Surgical Bioprosthetic Valves: An International, Multicenter Registry Study

Doff B. McElhinney, Allison K. Cabalka, Jamil A. Aboulhosn, Andreas Eicken, Younes Boudjemline, Stephan Schubert, Dominique Himbert, Jeremy D. Asnes, Stefano Salizzoni, Martin L. Bocks, John P. Cheatham, Tarek S. Momenah, Dennis W. Kim, Dietmar Schranz, Jeffery Meadows, John D.R. Thomson, Bryan H. Goldstein, Ivory Crittendon, Thomas E. Fagan, John G. WebbEric Horlick, Jeffrey W. Delaney, Thomas K. Jones, Shabana Shahanavaz, Carolina Moretti, Michael R. Hainstock, Damien P. Kenny, Felix Berger, Charanjit S. Rihal, Danny Dvir

Research output: Contribution to journalArticle

88 Scopus citations

Abstract

Off-label use of transcatheter aortic and pulmonary valve prostheses for tricuspid valve-in-valve implantation (TVIV) within dysfunctional surgical tricuspid valve (TV) bioprostheses has been described in small reports. Methods and Results-An international, multicenter registry was developed to collect data on TVIV cases. Patient-related factors, procedural details and outcomes, and follow-up data were analyzed. Valve-in-ring or heterotopic TV implantation procedures were not included. Data were collected on 156 patients with bioprosthetic TV dysfunction who underwent catheterization with planned TVIV. The median age was 40 years, and 71% of patients were in New York Heart Association class III or IV. Among 152 patients in whom TVIV was attempted with a Melody (n=94) or Sapien (n=58) valve, implantation was successful in 150, with few serious complications. After TVIV, both the TV inflow gradient and tricuspid regurgitation grade improved significantly. During follow-up (median, 13.3 months), 22 patients died, 5 within 30 days; all 22 patients were in New York Heart Association class III or IV, and 9 were hospitalized before TVIV. There were 10 TV reinterventions, and 3 other patients had significant recurrent TV dysfunction. At follow-up, 77% of patients were in New York Heart Association class I or II (P<0.001 versus before TVIV). Outcomes did not differ according to surgical valve size or TVIV valve type. Conclusions-TVIV with commercially available transcatheter prostheses is technically and clinically successful in patients of various ages across a wide range of valve size. Although preimplantation clinical status was associated with outcome, many patients in New York Heart Association class III or IV at baseline improved. TVIV should be considered a viable option for treatment of failing TV bioprostheses.

Original languageEnglish (US)
Pages (from-to)1582-1593
Number of pages12
JournalCirculation
Volume133
Issue number16
DOIs
StatePublished - Apr 19 2016

Keywords

  • Ebstein anomaly
  • endocarditis
  • heart valves
  • rheumatic heart disease
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    McElhinney, D. B., Cabalka, A. K., Aboulhosn, J. A., Eicken, A., Boudjemline, Y., Schubert, S., Himbert, D., Asnes, J. D., Salizzoni, S., Bocks, M. L., Cheatham, J. P., Momenah, T. S., Kim, D. W., Schranz, D., Meadows, J., Thomson, J. D. R., Goldstein, B. H., Crittendon, I., Fagan, T. E., ... Dvir, D. (2016). Transcatheter Tricuspid Valve-in-Valve Implantation for the Treatment of Dysfunctional Surgical Bioprosthetic Valves: An International, Multicenter Registry Study. Circulation, 133(16), 1582-1593. https://doi.org/10.1161/CIRCULATIONAHA.115.019353