Page 41 - Journal of Structural Heart Disease Volume 1, Issue 3

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Original Scientific Article
Video 9. Angiogram after release showing the competence of the newly implanted tricuspid valve. (Boudjemline, JACC. 2005;46:360-5).
A second Sapien® valve 26 mm was then implanted just proximal to the first one solving the tricuspid leak. This is likely due to that Sapien® valve has a cov- ered length of only 10 mm, significantly shorter than the Melody prosthesis (up to 23 mm).
These issues may be resolved in the future with the development of specific devices with larger diame- ters and longer covered lengths, more appropriate for transcatheter valve implantation in the tricuspid position.
Heterotopic TV Replacement or Caval Valve Implantation (CAVI)
Lauten et al. [40, 41] evaluated in an animal study a percutaneous approach to treat native TV failure using heterotopic valve implantation in the central venous position. Using a right internal jugular vein approach authors implanted two self-expanding ni- tinol stents containing a porcine pulmonary valve in the superior and inferior caval veins of 13 sheep presenting severe tricuspid regurgitation. All but one valve was correctly deployed as intended (one device embolization in the right atrium) leading to a signifi- cant decrease of central venous pressure and cardiac output. This interesting concept with lack of intracar- diac foreign material preventing venous flow rever-
Video 10. Echographic Video in long axis view after transcath- eter valve implant showing good function of the leaflets. (Boud- jemline, JACC. 2005;46:360-5).
sals and possibly hepatic complications fails to keep the right atrial and ventricular dilatation under check and may lead to potential deleterious hemodynamic and rhythmic effects.
Subsequently, the first-in-man application of this concept was performed as a compassionate treat- ment in a 79-year-old female patient with severe func- tional tricuspid regurgitation. Through the femoral vein, a custom-made self-expanding valved stent was implanted into the inferior vena cava, anchored at the cavoatrial junction. After deployment, excellent valve function was observed without paravalvular leakage resulting in a marked reduction in caval pressure. The patient experienced improved physical capacity and a partial reduction of ascites. The patient died 3 months after the procedure from intracranial haem- orrhage (Figure 4). Autopsy confirmed an unchanged position and excellent function of the valve in the IVC without evidence of degeneration, thrombus forma- tion, or other causes of dysfunction [42, 43]. The same team published recently the case of a similar case of an 83 years-old female who underwent implantation of 2 custom-made self-expanding valved stents into the superior and inferior vena cava without compli- cation. The procedure (CAVI) resulted in an imme- diate and sustained hemodynamic improvement. Moreover, the patient showed a substantial clinical
Jalal, Z. et al.
Transcatheter Tricuspid Valve Therapies