The Journal of invasive cardiology · 2025
Long-term outcomes after transcatheter tricuspid valve-in-valve replacement.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Voisine Émile, Del Portillo Juan Hernando, Desjardins Laurent, Houde Christine, Perron Jean, Jacques Frédéric, Chetaille Philippe, Philippon François, Laflamme Émilie, Bédard Élisabeth, Rodés-Cabau Josep
Аннотация
OBJECTIVES: Transcatheter tricuspid valve-in-valve (ViV) replacement has emerged as a less invasive alternative to redo surgery in patients with failing bioprosthetic tricuspid valves. While short- and mid-term outcomes have been reported, data on long-term follow-up remain limited.
METHODS: The authors conducted a single-center observational study including 12 consecutive patients who underwent transcatheter tricuspid ViV replacement. Clinical, echocardiographic, and procedural data were prospectively collected. Patients were followed at 1 and 12 months, and yearly thereafter; follow-up included annual clinical visits and echocardiography.
RESULTS: The mean age of the patients was 45 years (range, 23-69 years); 92% were women, and the indication for ViV was prosthetic valve regurgitation in most (58%) cases. A balloon-expandable SAPIEN valve (Edwards Lifesciences) was implanted in all cases, with 100% procedural success. After a mean follow-up of 6 years (range, 1-11 years), 3 (25%) patients died, and 1 was readmitted because of heart failure. Functional status improved significantly, with all surviving patients in New York Heart Association class I or II at last follow-up. Transvalvular gradients remained stable over time in 83% of the patients. Two (17%) patients developed bioprosthetic valve dysfunction during follow-up: one due to significant tricuspid stenosis and the other due to severe tricuspid regurgitation.
CONCLUSIONS: Tricuspid ViV replacement offers durable symptomatic improvement and stable prosthesis function during long-term follow-up in most cases. This study is the first to report outcomes greater than or equal to 5 years in this population and supports the continued use of ViV as a viable option for these patients. Larger studies are warranted to validate these findings.
METHODS: The authors conducted a single-center observational study including 12 consecutive patients who underwent transcatheter tricuspid ViV replacement. Clinical, echocardiographic, and procedural data were prospectively collected. Patients were followed at 1 and 12 months, and yearly thereafter; follow-up included annual clinical visits and echocardiography.
RESULTS: The mean age of the patients was 45 years (range, 23-69 years); 92% were women, and the indication for ViV was prosthetic valve regurgitation in most (58%) cases. A balloon-expandable SAPIEN valve (Edwards Lifesciences) was implanted in all cases, with 100% procedural success. After a mean follow-up of 6 years (range, 1-11 years), 3 (25%) patients died, and 1 was readmitted because of heart failure. Functional status improved significantly, with all surviving patients in New York Heart Association class I or II at last follow-up. Transvalvular gradients remained stable over time in 83% of the patients. Two (17%) patients developed bioprosthetic valve dysfunction during follow-up: one due to significant tricuspid stenosis and the other due to severe tricuspid regurgitation.
CONCLUSIONS: Tricuspid ViV replacement offers durable symptomatic improvement and stable prosthesis function during long-term follow-up in most cases. This study is the first to report outcomes greater than or equal to 5 years in this population and supports the continued use of ViV as a viable option for these patients. Larger studies are warranted to validate these findings.