Schamroth Pravda Nili, Vaknin Assa Hana, Levi Amos, Witberg Guy, Shapira Yaron, Vaturi Mordechai, Orvin Katia, Talmor Barkan Yeela, Hamdan Ashraf, Mishaev Raffael, Sharoni Ram, Perl Leor, Sagie Alexander, Kornowski Ran, Codner Pablo
Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel.
J Clin Med. 2022 May 9;11(9):2667. doi: 10.3390/jcm11092667.
The valve-in-valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the tricuspid position. We report on the outcomes of patients treated by a transcatheter tricuspid valve-in-valve (TT-ViV) implantation for symptomatic SVD in the tricuspid position during the years 2010-2019 at our center. Three main outcomes were examined during the follow-up period: TT-ViV hemodynamic data per echocardiography, mortality and NYHA functional class. Our cohort consisted of 12 patients with a mean age 65.4 ± 11.9 years, 83.3% male. The mean time from initial valve intervention to TT-ViV was 17.4 ± 8.7 years. The indications for TT-ViV were varied (41.7% for predominant regurgitation, 33.3% for predominant stenosis and 25.0% with a mixed pathology). All patients were treated with a balloon-expandable device. The mean follow-up was 3.4 ± 1.3 years. Tricuspid regurgitation was ≥ moderate in 57.2% of patients prior to the procedure and this decreased to 0% following the procedure. The mean transtricuspid valve gradients mildly decreased from the mean pre-procedural values of 9.0 mmHg to 7.0 mmHg at one month following the procedure ( = 0.36). Mortality at one year was 8.0% (95% CI 0-23). At the baseline, 4 patients (33.3%) were in NYHA functional class III/IV; this was reduced to 2 patients (18.2%) at the one year follow-up and both were in NYHA III. The TT-ViV procedure offered a safe, feasible and less invasive treatment option for patients with SVD in our detailed cohort.
瓣中瓣（ViV）技术是治疗三尖瓣位生物瓣结构性瓣膜退变（SVD）的一种新兴替代方法。我们报告了2010年至2019年期间在我们中心接受经导管三尖瓣瓣中瓣（TT-ViV）植入术治疗有症状三尖瓣位SVD患者的结果。随访期间检查了三项主要结果：经超声心动图测量的TT-ViV血流动力学数据、死亡率和纽约心脏协会（NYHA）心功能分级。我们的队列包括12例患者，平均年龄65.4±11.9岁，男性占83.3%。从初次瓣膜干预到TT-ViV的平均时间为17.4±8.7年。TT-ViV的适应证各不相同（主要反流占41.7%，主要狭窄占33.3%，混合病变占25.0%）。所有患者均采用球囊扩张装置治疗。平均随访时间为3.4±1.3年。术前57.2%的患者三尖瓣反流≥中度，术后降至0%。术后1个月，经三尖瓣平均压差从术前的平均9.0 mmHg轻度降至7.0 mmHg（P=0.36）。1年时的死亡率为8.0%（95%CI 0-23）。基线时，4例患者（33.3%）处于NYHA心功能III/IV级；1年随访时降至2例患者（18.2%），且均为NYHA III级。在我们的详细队列中，TT-ViV手术为SVD患者提供了一种安全、可行且侵入性较小的治疗选择。
