Author + information
- Received March 6, 2015
- Accepted March 12, 2015
- Published online July 1, 2015.
- Alduz S. Cabasa, MD∗,
- Mackram F. Eleid, MD†,
- Charanjit S. Rihal, MD†,
- Hector R. Villarraga, MD†,
- Thomas A. Foley, MD‡ and
- Rakesh M. Suri, MD, DPhil∗∗ ()
- ∗Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
- †Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
- ‡Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Rakesh M. Suri, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, J4-1, Cleveland, Ohio 44195.
We describe a percutaneous transcatheter tricuspid valve-in-ring implantation using the Sapien XT prosthesis (Edward Lifesciences, Irvine, California) (1,2). A 68-year-old woman with rheumatic heart disease and 2 previous sternotomies including tricuspid valve repair with a 32-mm Carpentier-Edwards (Irvine, California) annuloplasty ring presented 2 years prior with severe tricuspid valve regurgitation (annulus dilation and tenting of the leaflet) and pulmonary hypertension (right ventricular systolic pressure of 46 mm Hg) related to left ventricular diastolic dysfunction. After multidisciplinary evaluation, a percutaneous approach was recommended to avoid increased risk of third-time redo sternotomy. The procedure was planned using a cardiac computed tomography–derived 3-dimensional printed model created using an Objet Connex 350 printer (Stratasys, Eden Prairie, Minnesota) (Figure 1). Using this model, the prosthesis size was selected and “test deployed” to verify adequacy (Online Video 1). The actual transcatheter tricuspid valve-in-ring implantation was performed in the hybrid operating suite under general anesthesia. The right common femoral vein was accessed percutaneously. With an Amplatz super-stiff wire (Boston Scientific, Marlborough, Massachusetts) acting as a rail, a 29-mm Sapien XT valve was advanced across the tricuspid valve annulus. The stented valve was balloon inflated with an additional 1 cc of contrast saline solution to achieve optimal conical deployment (Figure 2, Online Video 2). Transesophageal echocardiography showed only mild perivalvular regurgitation in the septal region, as predicted in the printed model. Post-procedural 2-dimensional echocardiography showed mild tricuspid valve regurgitation with a transvalvular gradient of 3 mm Hg (Figure 3, Online Video 3). The patient’s dyspnea improved prior to discharge from hospital 4 days later. The long-term effectiveness of this off-label procedure is still unknown and warrants further studies.
For supplemental videos, please see the online version of this paper.
Dr. Suri received research support to the Division of Cardiovascular Surgery from Sorin, Abbott Vascular, St. Jude Medical, and Edwards Lifesciences; was a co-primary investigator on behalf of Abbott for the COAPT trial; is the national primary investigator on behalf of Sorin on the Perceval trial; applied for patents in conjunction with Sorin; and served on the steering committees of the COAPT trial for Abbott and the PORTICO trial for St. Jude Medical. All other authors have reported that they have no conflicts of interest relevant to the contents of this paper to disclose. Drs. Cabasa and Eleid contributed equally to this work.
- Received March 6, 2015.
- Accepted March 12, 2015.
- 2015 American College of Cardiology Foundation