3 years ago

Outcomes of Transcatheter Tricuspid Valve-in-Valve Implantation in Patients with Ebstein Anomaly

We sought to describe the acute results and short to medium-term durability of transcatheter tricuspid valve-in-valve (TVIV) implantation within surgical bioprostheses among patients with Ebstein anomaly (EA). Cases were identified from a voluntary, multicenter, international registry of 29 institutions that perform TVIV. Demographic, clinical, procedural, and follow-up data were analyzed. Eighty-one patients with EA underwent TVIV from 2008-2016. Thirty-four patients (42%) were NYHA class 3/4 at time of tricuspid valve-in-valve. The most common indication for TVIV was the presence of moderate or severe tricuspid regurgitation (40%). Most patients received a Melody valve (64%). TVIV was ultimately successful in all patients, and there was no procedural mortality. Four patients (5%) developed acute valve thrombosis, 4 patients (5%) developed endocarditis, and 9 patients (11%) developed valve dysfunction not related to thrombosis or endocarditis. Eight patients (10%) underwent reintervention (2 transcatheter, 6 surgical) due to thrombosis (3), endocarditis (2), other valve dysfunction (2) and patient-prosthesis mismatch without valve dysfunction (1). Among 69 patients who were alive without reintervention at latest follow-up, 96% of those with NYHA status reported were class 1/2, a significant improvement from baseline (62% NYHA class 1/2, p<0.001). In conclusion, transcatheter TVIV offers a low-risk, minimally invasive alternative to surgical TV re-replacement in patients with EA and a failing TV bioprosthesis.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917316272

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