Page 42 - Journal of Structural Heart Disease Volume 1, Issue 3

Original Scientific Article
148
Video 11. Echographic Video in transverse axis view after tran- scatheter valve implant showing the position of the valve stent in regards with the original tricuspid annulus. (Boudjemline, JACC. 2005;46:360-5).
improvement of heart failure symptoms, normaliza- tion of liver function, and improvement of physical capacity after 12 months of follow-up [44]. To avoid right heart failure by increased preload, it seems that preserved right ventricular function is mandatory for the success of this procedure. Furthermore, because these valves are implanted in the low-pressure sys- tem, lifelong anticoagulation is required.
Laule et al. [45] reported a case series of three pa- tients who had percutaneous caval valve implantation (CAVI) for severe tricuspid regurgitation (Videos 12 and 13). Procedures were performed using Edwards Sapien XT (29 mm) valved stent following superior and inferior vena cava prestenting. No complication occurred. After 1 month, valve function remained ex- cellent without regurgitation or leakage and all pa- tients improved by at least 1 NYHA class. In patients with enlarged inferior vena cava, a mini-invasive surgical caval banding can be performed to allow a safe valved stent implantation in appropriate landing zone [46].
Despite encouraging first results, further studies are warranted to evaluate the benefit of the het- erotopic transcatheter tricuspid valve implantation procedure during long-term follow-up in larger co- horts. Furthermore, as this concept is targeted for
Video 12.
Video showing preparation, implantation and angio- gram of two self-expandable valved stents in a CAVI procedure. (Lauten, Circ Cardiovasc Interv. 2014;7:268-72).
high-risk patients in end-stage heart disease, the costs involved for this type of procedure should be taken into account and carefully weighed against the clinical benefit.
Transcatheter Tricuspid Valvuloplasty
Percutaneous procedures may be an attractive al- ternative to surgery for patients who are high-risk sur- gical candidates. In patients with native failed tricuspid valve, some of the concepts that have been developed for the percutaneous treatment of mitral regurgitation may be adapted to percutaneous repair of the tricus- pid valve (percutaneous annuloplasty, edge-to-edge repair) [47, 48]. The Millipede system (Millipede, LLC, Ann Arbor, Michigan, USA) consists in placing a new tricuspid annular ring with a unique attachment sys- tem through a minimally invasive approach - surgical or percutaneous. This repositionable and retrievable device may restore the native tricuspid annular shape and diameter and thus treat functional tricuspid regur- gitation. It is currently under preclinical development. Furthermore, the use of the Mitralign Percutaneous Annuloplasty System (Mitralign Inc., Boston, Massa- chusetts, USA) or the QuantumCor System (Quan- tumCor, Inc., Bothell, Washington, USA) may in a near
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 3: 137-151