Transcatheter Treatment of Tricuspid Regurgitation Due to Surgical Ring Dehiscence: Combining Intravalvular and Paravalvular Approaches.

OBJECTIVE

Our objective was to describe a transcatheter approach to treat severe tricuspid regurgitation and paravalvular regurgitation from a partially dehisced surgical ring.

KEY STEPS: The procedure was performed under general anesthesia with transesophageal echocardiogram guidance. Femoral vein access with Swan-Ganz catheter (Edwards Lifesciences) was advanced to the right pulmonary artery (PA). Lunderquist wire (Cook Medical) was advanced through the Swan-Ganz catheter (Edwards Lifesciences). A 65-cm 26-F DrySeal sheath (W.L. Gore and Associates) was advanced over the wire to right PA. Valve size was confirmed with a 26-mm True Balloon (Becton, Dickinson and Company). A 26-mm Sapien S3 ULTRA valve (Edwards Lifesciences) was advanced, positioned at the ring, and deployed. Paravalvular leak at the site of dehiscence was then approached via an 8.5-F Agilist NxT steerable guide catheter (Abbott Vascular) and closed with a 27-mm Gore ASD occluder (W.L. Gore and Associates).

POTENTIAL PITFALLS: The number, shape, and size of paravalvular defects can affect adequate defect sealing and prosthetic stability, affecting the overall efficacy and safety of transcatheter approaches.

TAKE-HOME MESSAGE: Transcatheter implantation of a transcatheter heart valve and atrial septal defect occluder can be used to treat high-risk patients with dehisced tricuspid rings complicated by intravalvular and paravalvular regurgitation.