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Outcomes of Transcatheter Tricuspid Valve-in-Valve Implantation in Patients With Ebstein Anomaly. 2018
Nathaniel W Taggart, and
Allison K Cabalka, and
Andreas Eicken, and
Jamil A Aboulhosn, and
John D R Thomson, and
Brian Whisenant, and
Martin L Bocks, and
Stephan Schubert, and
Thomas K Jones, and
Jeremy D Asnes, and
Thomas E Fagan, and
Jeffery Meadows, and
Mark Hoyer, and
Mary H Martin, and
Frank F Ing, and
Daniel R Turner, and
Azeem Latib, and
Aphrodite Tzifa, and
Stephan Windecker, and
Bryan H Goldstein, and
Jeffrey W Delaney, and
James A Kuo, and
Susan Foerster, and
Matthew Gillespie, and
Gianfranco Butera, and
Shabana Shahanavaz, and
Eric Horlick, and
Younes Boudjemline, and
Daniel Dvir, and
Doff B McElhinney, and
Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota. Electronic address: taggart.nathaniel@mayo.edu.
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 to 2016. Thirty-four patients (42%) were New York Heart Association (NYHA) class 3/4 at time of TVIV. 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 tricuspid valve re-replacement in patients with EA and a failing tricuspid valve bioprosthesis.
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