Hybrid Perventricular Venus P-Valve Implantation Via Mini-Thoracotomy in a Patient With Mechanical Tricuspid Valve.

BACKGROUND

Chronic severe pulmonary regurgitation following repair of right ventricular outflow dysfunction may result in progressive right ventricular dilatation, heart failure, and arrhythmias. In patients with a complex surgical history, particularly those with mechanical tricuspid valve prostheses, standard transvenous access for pulmonary valve implantation can be technically challenging and carries risks for prosthetic valve injury.

CASE SUMMARY: We report a successful hybrid perventricular Venus P-Valve implantation via left mini-thoracotomy in a 29-year-old man with 2 prior cardiac surgeries, mechanical mitral and tricuspid valves. The procedure was performed on the beating heart without cardiopulmonary bypass, avoiding the risks of a third open-heart surgery.

DISCUSSION: This case highlights the advantages of a hybrid perventricular pulmonary valve implantation strategy in patients with a mechanical tricuspid valve.

TAKE-HOME MESSAGE: Hybrid perventricular access can expand transcatheter self-expanding pulmonary valve options in selected high-risk redo patients with a mechanical tricuspid valve and enlarged right ventricular outflow tract.