Percutaneous Bicaval Valve Implantation for Transcatheter Treatment of Tricuspid Regurgitation
Clinical Observations and 12-Month Follow-Up
Severe tricuspid regurgitation (TR) frequently constitutes a high risk for surgical correction.1 For inoperable patients with TR, transcatheter caval valve implantation has been suggested.2 Herein, we report the human application and 12-month follow-up after first bicaval implantation of self- expanding valves into the superior (SVC) and inferior (IVC) vena cava as interventional concept for severe TR.3
Patient and Procedure
The procedure was performed as compassionate treatment in an 83-year-old female with severe, long-standing functional and structural TR after University Hospital Jena institutional review board approval. At admission, she was in New York Heart Association-stage IV and presented symptoms of chronic right heart failure with peripheral edema, ascites, and orthopnea. Synthetic liver function was impaired with reduced serum albumin and cholinesterase because of congestive hepatopathy, echocardiography demonstrated right ventricle enlargement with preserved systolic function. Right heart catheterization confirmed severe TR with a ventricular wave (v-wave) in the right atrium (RA), the SVC, and the IVC of 32, 27, and 28 mm Hg, respectively, as well as a slightly elevated pulmonary artery pressure and vascular resistance. Hemodynamics, laboratory, and clinical parameters are detailed in the Table.
Based on computed tomography-angiographic images, 2 self-expanding percutaneous heart valves were custom-made with 10% to 20% oversizing to fit the anticipated implantation site in the SVC and IVC.4 The IVC valve was designed with the upper segment protruding into the RA with the biological valve located above …