Long-term follow-up after trans-catheter tricuspid valve-in-valve replacement with balloon-expandable aortic valves.

Background: Transcatheter tricuspid VIV replacement has been proposed as a feasible option for high-risk patients with previous tricuspid valve replacement that undergo valve degeneration causing refractory heart failure. However, little is known about the long-term outcome of patients treated with transcatheter tricuspid VIV. We evaluate the safety of transcatheter tricuspid valve-in-valve (VIV) replacement by using balloon-expandable aortic valve stents and the long-term follow-up.

Methods And Results: From January 2013 to March 2016, 4 patients underwent transcatheter tricuspid VIV in our center using balloon-expandable Edwards Sapien-XT and Sapien-3 valves. In all cases the procedure succeeded with significant improvement of the tricuspid valve area (from 0.98±0.29cm to 3.1±0.45cm, p=0.005), right atrial pressure (from 21±7.78mmHg to 8.5±2.51mmHg, p=0.025) and mean trans-valvular gradient (from 11.5±4mmHg to 3.32±1.28mmHg, p=0.02). Three out of 4 patients presented a follow up longer than 2.5years. At median follow up of 32months (range 9-47months) all patients were alive and presented with NYHA class I-II. Only one patient, who presented impaired right ventricular function at baseline, experienced re-hospitalization during the follow-up time. Echocardiographic assessment at long-term disclosed a well-maintained hemodynamic performance with low trans-valvular gradients and no significant valvular regurgitation in all cases.

Conclusions: In our experience, trans-catheter tricuspid VIV demonstrated good long-term results in terms of valve performance and functional class improvement at 32months from intervention.