Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation
Fanglin Lu, An Zhao, Ye Ma, Zhigang Song, Cheng-Liang Cai, Bailing Li, Guangwei Zhou, Lin Han, Jun Wang, Yifan Bai, Xiaohong Liu, Jiafeng Wang, Xu Meng, Haibo Zhang, Jian Yang, Nianguo Dong, Shengshou Hu, Xiangbin Pan, Anson Cheung, Fan Qiao, Zhiyun Xu
Abstract
OBJECTIVE: Tricuspid regurgitation (TR) is a common valvular heart disease with unsatisfactory medical therapeutics and high surgical mortality. The present study aims to evaluate the safety and effectiveness of transcatheter tricuspid valve replacement (TTVR) in high-risk patients with severe TR. METHODS: This was a compassionate multicentre study. Between September 2018 and November 2019, 46 patients with TR who were not suitable for surgery received compassionate TTVR under general anaesthesia and the guidance of trans-oesophageal echocardiography and fluoroscopy in four institutions. Access to the tricuspid valve was obtained via a minimally invasive thoracotomy and transatrial approach. Patients' data at baseline, before discharge, 30 days and 6 months after the procedure were collected. RESULTS: All patients had severe TR with vena contracta width of 12.6 (11.0, 14.5) mm. Procedural success (97.8%) was achieved in all but one case with right ventricle perforation. The procedural time was 150.0 (118.8, 180.0) min. Intensive care unit time was 2.0 (1.0, 4.0) days. 6-month mortality was 17.4%. Device migration occurred in one patient (2.4%) during follow-up. Transthoracic echocardiography at 6 months after operation showed TR was significantly reduced (none/trivial in 33, mild in 4 and moderate in 1) and the primary safety end point was achieved in 38 cases (82.6%). Patients suffered from peripheral oedema and ascites decreased from 100.0% and 47.8% at baseline to 2.6% and 0.0% at 6 months. CONCLUSIONS: The present study showed TTVR was feasible, safe and with low complication rates in patients with severe TR.