Page 37 - Journal of Structural Heart Disease Volume 1, Issue 3

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Original Scientific Article
Video 5. Echographic Video showing regurgitation of the implanted bioprosthetic surgical valve (Zegdi et al, JACC. 2006;48:1365-8).
choring to the large surgically inserted bioprosthesis (Figure 2). Type and diameter of balloons used to de- liver the stents largely depends on the inner diame- ter of the surgical valve. Following the creation of the landing zone, transcatheter valves insertion could be performed using conventional technique. Using this technique, we treated patients with regurgitant surgi- cal valve up to 33-mm in diameter. In our experience, the creation of free tricuspid regurgitation following prestenting is well tolerated and no rush is needed to implant the valve.
Excluding the transatrial hybrid procedures with direct right atrial puncture [27], completely percu- taneous tricuspid valve-in-valve implantations were performed using either a femoral or an internal jugu- lar venous approach.
In cases where the tricuspid valve prosthesis is di- rected toward the superior vena cava, the transjug- ular approach should be preferred to obtain a better angle when positioning the valve, especially with the Edwards SAPIEN valve that is a larger and more rigid device. Nevertheless, despite these considerations, the decision about the approach has to be taken separate- ly for each patient regarding patient’s valve anatomy.
Rapid pacing is generally performed during Ed- wards SAPIEN implantation to allow accurate posi- tioning of this relatively short valve. It is usually not
Video 6. Angiogram showing the implantation of the retriev- able valve stent. The stent is slowly opened inside the biopros- thesis than closed and repositioned and finally released and left in position. (Zegdi et al, JACC. 2006;48:1365-8).
required with the longer Melody valve. In our experi- ence, rapid pacing is not necessary and femoral veins provide excellent access to the tricuspid. During po- sitioning on the valved stent, the assembly can easily be aligned (horizontalized) to the tricuspid annulus by maintaining forward pressure on the stiff wire thus mimicking jugular pathway.
The Edwards SAPIEN® valve has the advantage of being available in larger sizes with relatively shorter stent lengths (the 26-mm valve measures 16-mm in length) when compared with the MELODY® Valve (the stent measures 23 mm in length when dilated to 22 mm). Moreover, its shorter stent may not protrude significantly into the adjacent cardiac chambers. On the other hand, correct positioning of this shorter valve may be more difficult, although rapid pacing may be used to allow safer implantation, and ma- nipulation of the Melody delivery system is easier in complex anatomies with important angulation of the tricuspid annulus in relation to the superior vena cava and inferior vena cava.
Despite experience is accumulating worldwide with these two devices, there is currently lack of data to conclude that one of the devices is superior to the other in this off-label use.
Jalal, Z. et al.
Transcatheter Tricuspid Valve Therapies