Page 31 - Journal of Structural Heart Disease Volume 3, Issue 5

Case Report
Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:157-162
DOI: https://doi.org/10.12945/j.jshd.2017.024.17
Received: May 29, 2017 Accepted: June 8, 2017 Published online: October 2017
Rapid Pacing Using the Guidewire During Transcatheter Tricuspid Valve-in-Valve Implantation
Amnon Eitan, MD*, Ariel Roguin, MD, PhD, Arthur Kerner, MD
Cardiology Department, Rambam Medical Center, Haifa, Israel
Abstract
Transcatheter valve replacement is now widely used to treat high-risk patients. This approach is also expanding to the tricuspid valve, mostly for “valve-in- valve” and “valve-in-ring” implantations. Rapid pacing during transcatheter valve implantation is used to reduce cardiac output and minimize the risk of valve dislodgement. Rapid pacing is usually done using the patient’s permanent pacemaker or a temporary pacing electrode that is usually introduced retrogradely into the left ventricle or coronary sinus. Here, we describe the use of the tricuspid valve-in-valve implantation super-sti guidewire for rapid pacing during implanta- tion of the valve. This approach may obviate the need for ancillary steps that may increase procedure time, X-ray exposure, and risk of complications.
Copyright © 2017 Science International Corp.
Key Words
Tricuspid valve-in-valve • Rapid pacing
Introduction
It is well recognized today that signi cant tricuspid valve regurgitation is associated with poor prognosis [1, 2]. The long-term results of tricuspid surgical re- pairs are suboptimal, with more than 25% of patients developing progressive moderate or severe valve re- gurgitation within 5 years of repair [3, 4]. Similar to bio- prostheses in other positions, tricuspid valve biopros- theses are prone to degeneration and dysfunction.
Tricuspid valve prosthesis longevity may be shorter than that of bioprosthetic valves in the systemic circu- lation,with75%to83%freedomfromreintervention at 8-10 years and <60% at 15 years [5–7].
Transcatheter valve replacement is now widely utilized to treat high-risk patients with native valve disease and is expanding to encompass degener- ated bioprosthetic valves. There are several reports of transcatheter tricuspid “valve-in-valve” and “valve-in- ring” implantations with reasonable short- and medi- um-term results [8, 9].
Rapid pacing during transcatheter valve implanta- tion is used to reduce cardiac output and minimize the risk of valve dislodgement. Although the lower pressure in the right ventricle may reduce the need for rapid pacing during valve implantation, it is used in most cases when the Sapien valve is implanted [8, 9]. Rapid pacing is usually done using the patient’s per- manent pacemaker or a temporary pacing electrode. The pacing electrode is usually introduced retro- gradely into the left ventricle or coronary sinus; other positions used are the right atrium or right ventricle [8, 9]. Placing a pacing electrode in the left ventricle requires additional arterial access. Any positioning of a dedicated pacing electrode is time-consuming and involves additional X-ray exposure. However, several published reports describe successful and safe rapid pacing using the left ventricle guidewire during valve implantation in transcatheter aortic valve replace- ment (TAVR) [10, 11].
* Corresponding Author:
Amnon Eitan, MD
Department of Cardiology
Rambam Medical Center
7 Efron Street, PO Box 9602, Haifa 31096, Israel
Tel.: +972 4 777 2181; Fax: +972 4 777 3451; E-Mail: eitancardio@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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