Page 31 - Journal of Structural Heart Disease Volume 1, Issue 3

Original Scientific Article
Journal of Structural Heart Disease, August 2015, Volume 1, Issue 3: 137-151
DOI: http://dx.doi.org/10.12945/j.jshd.2015.008.14
Received: October 19, 2014 Accepted: January 08, 2015 Published online: August 2015
Transcatheter Therapies for Tricuspid Valve Failure
Zakaria Jalal, MD1, Rachid Zegdi, MD, PhD2-4, Alexander Lauten, MD5, Patel Mehul, MD1, Younes Boudjemline, MD, PhD1,4,6*
Rachid Zegdi and Alexander Lauten have contributed equally to the writing of this paper.
1 Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Hôpital Necker-Enfants Malades, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Unité médico-chirurgicale, Paris, France
2 Inserm U970, Faculté de Necker, Paris, France
3 Service de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
4 Université Paris Descartes, Sorbonne Paris Cité, Paris, France
5 Klinik für Innere Medizin 1, Kardiologie, Erlanger Allee 101, 07743 Jena, Germany
6 EA 7328 FETUS, Faculté de Necker, Paris, France
Abstract
Tricuspid valve failure with low output state is a grow- ing problem in the management of structural heart dis- ease and stage D heart failure. Severe tricuspid valve disease either due to congenital or acquired etiology constitutes high risk for palliative or definitive surgi- cal correction. Limited progress is noted so far on the evolution of durable surgical techniques on tricuspid valve disease and spiraling down refractory right heart failure continues to be the Achilles heel in the manage- ment. Over the last decade, transcatheter therapies for the management of aortic and pulmonary valves have expanded the therapeutic options for patients deemed at high risk for conventional surgery. The intervention- al therapies to manage tricuspid valve failure have mostly been a surrogate use of established therapies for other valves. The numerous interventional strat- egies used on failing tricuspid valve include percu- taneous tricuspid valvuloplasty, percutaneous valve in valve, valve-in-ring implantation, and orthotopic/ heterotopic valve implantation using commercially available “off-label” device or dedicated custom-made devices. This review focuses on the different percuta- neous approaches and devices that have evolved for the management of tricuspid valve failure with varying anatomical substrates such as native tricuspid valves, annuloplasty rings or bioprosthesis.
Copyright © 2015 Science International Corp.
Key Words:
Transcatheter • Tricuspid valve • Congenital heart diseases • Tricuspid stenosis • Tricuspid insufficiency
Introduction
A variety of congenital and acquired etiologies af- fect the tricuspid valve. While congenital lesions such as tricuspid valve dysplasia or Ebstein’s anomaly cause organic involvement of the tricuspid valve apparatus, acquired lesions may be function with less obvious structural abnormality other than annular dilation, most commonly due to pulmonary hypertension or any other etiology causing severe right ventricular dilatation [1-3]. Once considered a dispensable valve, when tricuspid valve stenosis and/or regurgitation are severe, cardiac output decreases and patients develop spiralling down symptoms of right heart failure with congestive hepatosplenomegaly, peripheral oedema and cardiac cachexia. A wide variety of tricuspid valve surgeries such as valve repair with or without annu- loplasty and even valve replacement have produced just satisfactory results mostly due to the high opera- tive mortality of up to 22% in such patients deemed as very high-risk for perioperative events [2-4].
*Corresponding Author:
Younes Boudjemline, MD, PhD
Hôpital Necker Enfants Malades
Cardiologie Pédiatrique, 75015 Paris Cedex, France
Phone: +00331 44 49 43 57; Fax: +00331 44 49 5724; Email: younes.boudjemline@nck.aphp.fr
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2015 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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http://structuralheartdisease.org/