Double mitral and tricuspid transcatheter valve replacement

A 75-year-old woman was referred to our centre for management of a symptomatic (New York Heart Association [NYHA] Class III) severe (effective regurgitant orifice area: 44 mm²) secondary mitral regurgitation (MR). She had no previous medical history except for a dual-chamber pacemaker implantation for high-grade atrioventricular block two years earlier. Her Society of Thoracic Surgeons (STS) score was 4.0% and left ventricular ejection fraction was 55%. Owing to her frailty, the Heart Team recommended transcatheter management of this MR. Because of severe leaflet restriction and short length (6 mm) of the posterior leaflet (Figure 1A, Figure 1B), we considered a mitral valve replacement rather than a transcatheter edge-to-edge repair (TEER). A self-expanding bioprosthetic valve (Tendyne [Abbott]), was successfully deployed transapically via a left lateral thoracotomy with a good outcome. The 3-month follow-up found an asymptomatic patient, treated with Coumadin, with no residual MR (Moving image 1), a transprosthetic gradient of 2 mmHg, and a mild tricuspid regurgitation (TR).

At follow-up, successive echocardiography explorations highlighted worsening TR. Four years after the Tendyne implantation, the patient was...