Pulmonary Artery Denervation With Transcatheter Tricuspid Valve Replacement for Severe Tricuspid Regurgitation and Pulmonary Hypertension.

BACKGROUND

Pulmonary hypertension (PH) and severe tricuspid regurgitation (TR) are often comorbid, with negative prognostic implications. We hypothesized that sequential pulmonary artery denervation (PADN) and transcatheter tricuspid valve replacement (TTVR) could be a one-stop solution to optimize surgical results for such high-risk patients.

CASE SUMMARY: A very high-risk patient with systemic lupus erythematosus who had severe TR and mixed PH was successfully treated with PADN and TTVR in a single sequential operation.

DISCUSSION: Both pulmonary artery pressure and right ventricular (RV) function are predictors of outcomes after both open surgical and transcatheter tricuspid repair or TTVR. We describe a novel, safe technique to immediately reduce the pulmonary artery systolic pressure in a patient with PH and severe TR; this is to our knowledge the first report of such a completely percutaneous, combined operation in the literature.

TAKE-HOME MESSAGE: Preoperative PADN may be a safe and effective way to reduce pulmonary artery pressures and mitigate the risk of postoperative acute RV failure due to RV afterload mismatch in patients with PH and severe TR.