Image – Interventional flashlight

DOI: 10.4244/EIJ-D-18-00970

Transcatheter tricuspid valve replacement for pacemaker-associated tricuspid regurgitation

Neil P. Fam*, MD, MSc; Janine S. Eckstein, MD; Sumeet Gandhi, MD; Mark D. Peterson, MD, PhD

Figure 1. Procedural steps for Gate implantation. A) Transoesophageal (TEE) view demonstrating pacemaker lead and (B) severe tricuspid regurgitation (TR). C) Fluoroscopic positioning and (D) deployment of the Gate valve. E) Post-implantation TEE view demonstrating Gate valve, lead and (F) abolishment of TR. *PPM lead; ➞: Gate valve; RA: right atrium; RCA: right coronary artery; RV: right ventricle

An 82-year-old man presented with severe tricuspid regurgitation (TR) and right heart failure. Despite optimal medical therapy, he remained in NYHA Class III with significant fatigue and oedema. Past history included atrial fibrillation and remote permanent pacemaker (PPM). Transoesophageal echocardiography (TEE) demonstrated a dilated right ventricle (RV) with moderate dysfunction, severe TR with leaflet tethering and a large (15 mm) coaptation gap, and impingement of the posterior tricuspid leaflet by the PPM lead, precluding transcatheter edge-to-edge repair (Figure 1A, Figure 1B, Moving image 1-Moving image 6). Left ventricular function was normal, with no left-sided valve disease or pulmonary hypertension. After Heart Team review, the patient was accepted for transcatheter tricuspid valve replacement.

The Gate™ Tricuspid Valved Stent (NaviGate Cardiac Structures Inc., Lake Forest, CA, USA) is a self-expanding valved stent with equine pericardial leaflets designed to engage the tricuspid annulus with minimal extension into the atrium or ventricle. Atrial winglets and ventricular graspers anchor the bioprosthesis to the tricuspid annulus and leaflets1. A Gate 44 mm valve was implanted via the right atrial approach with mini-thoracotomy under TEE and fluoroscopic guidance (Figure 1C, Figure 1D, Moving image 7, Moving image 8), jailing the PPM lead. TEE demonstrated excellent valve function with only trace paravalvular regurgitation and a mean gradient of 1 mmHg (Figure 1E, Figure 1F, Moving image 9, Moving image 10). PPM interrogation demonstrated stable lead thresholds, with no change in position. At follow-up, the patient was clinically improved with resolution of fatigue and oedema. Repeat echocardiography demonstrated sustained TR reduction, with decreased RV size and normal function.

Transcatheter tricuspid repair is being used with increasing frequency and success in the treatment of severe TR2, including lead-associated TR3. However, in patients with advanced RV remodelling and severe leaflet tethering, large coaptation gaps or PPM lead impingement, transcatheter tricuspid valve replacement may provide a more definitive solution. Further studies will define the efficacy and safety of transcatheter tricuspid valve replacement in patients with severe TR and heart failure.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Supplementary data

To read the full content of this article, please download the PDF.

Volume 14 Number 15
Feb 7, 2019
Volume 14 Number 15
View full issue


Key metrics

On the same subject

Research correspondence

10.4244/EIJ-D-23-00077 Aug 7, 2023
Right heart remodelling after bicaval TricValve implantation in patients with severe tricuspid regurgitation
Amat-Santos I et al
free

SPECIAL REPORT

10.4244/EIJV11I13A296 Apr 20, 2016
First transfemoral percutaneous edge-to-edge repair of the tricuspid valve using the MitraClip system
Wengenmayer T et al
free

Image – Interventional flashlight

10.4244/EIJ-D-21-00614 Dec 17, 2021
Transfemoral transcatheter tricuspid valve replacement after failed leaflet repair
Wild M et al
free

Clinical research

10.4244/EIJ-D-21-00095 Nov 19, 2021
Twelve-month outcomes of the LuX-Valve for transcatheter treatment of severe tricuspid regurgitation
Sun Z et al
free

10.4244/EIJV15I10A159 Nov 15, 2019
The five Ws of transcatheter tricuspid valve repair: Who, What, When, Where, and Why
Williams A et al
free

10.4244/EIJV12I15A292 Feb 3, 2017
The forgotten valve no more
Mylotte D
free

Research correspondence

10.4244/EIJ-D-22-00517 Feb 6, 2023
A first-in-human study of transjugular transcatheter tricuspid valve replacement with the LuX-Valve Plus system
Zhang Y et al
free
Trending articles
243.1

State of the art

10.4244/EIJ-D-21-01117 Sep 20, 2022
Recanalisation of coronary chronic total occlusions
Di Mario C et al
free
188.65

State-of-the-Art Review

10.4244/EIJ-D-21-01034 Jun 3, 2022
Management of in-stent restenosis
Alfonso F et al
free
169.3

Translational research

10.4244/EIJ-D-21-00824 May 15, 2022
Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation
Toth GG et al
free
167.05

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
151.28

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
110.35

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 6.2
2022 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2023)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved