Outcomes of Transcatheter Tricuspid Valve-in-Valve Implantation in Patients With Ebstein Anomaly - 22/11/17

Doi : 10.1016/j.amjcard.2017.10.017

Nathaniel W. Taggart, MD ^a,^* , Allison K. Cabalka, MD ^a, Andreas Eicken, MD, PhD ^b, Jamil A. Aboulhosn, MD ^c, John D.R. Thomson, MD ^d, Brian Whisenant, MD ^e, Martin L. Bocks, MD ^f, Stephan Schubert, MD ^g, Thomas K. Jones, MD ^h, Jeremy D. Asnes, MD ⁱ, Thomas E. Fagan, MD ^j, Jeffery Meadows, MD ^k, Mark Hoyer, MD ^l, Mary H. Martin, MD ^m, Frank F. Ing, MD ⁿ, Daniel R. Turner, MD ^o, Azeem Latib, MBBCh ^p, Aphrodite Tzifa, MD ^q, Stephan Windecker, MD ^r, Bryan H. Goldstein, MD ^s, Jeffrey W. Delaney, MD ^t, James A. Kuo, MD ^u, Susan Foerster, MD ^v, Matthew Gillespie, MD ^w, Gianfranco Butera, MD, PhD ^x, Shabana Shahanavaz, MD ^y, Eric Horlick, MD ^z, Younes Boudjemline, MD, PhD ^aa, Daniel Dvir, MD ^bb, Doff B. McElhinney, MD ^cc
for the
VIVID Registry
^a Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
^b Division of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany
^c Division of Cardiology, University of California-Los Angeles, Los Angeles, California
^d Division of Pediatric and Adult Congenital Cardiology, Leeds General Infirmary, Leeds, United Kingdom
^e Intermountain Heart Institute, Murray, Utah
^f Department of Pediatrics, Division of Pediatric Cardiology, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
^g Division of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
^h Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington
ⁱ Section of Pediatric Cardiology, Yale University, New Haven, Connecticut
^j Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee
^k Division of Pediatric Cardiology University of California-San Francisco Medical Center, San Francisco, California
^l Division of Pediatric Cardiology, Riley Hospital for Children, Indianapolis, Indianapolis
^m Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
ⁿ Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, California
^o Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, Michigan
^p Cardothoracic and Vascular Department, San Raffaele Hospital, Milan, Italy
^q Department of Pediatric Cardiology, Mitera Children's Hospital, Athens, Greece
^r Department of Cardiovascular Diseases, Swiss Cardiovascular Center, Bern, Switzerland
^s Division of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
^t Division of Cardiology, Children's Hospital and Medical Center of Omaha, Omaha, Nebraska
^u Division of Cardiology, Cook Children's Medical Center, Ft. Worth, Texas
^v Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
^w Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^x Division of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, Milan, Italy
^y Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri
^z Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
^aa Division of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
^bb Division of Pediatric Cardiology, St. Paul's Hospital, Vancouver, Canada
^cc Division of Pediatric Cardiac Surgery, Division of Pediatric Cardiology, Stanford University, Palo Alto, California

^*Corresponding author: Tel: (507) 266 0676; fax (507) 284 3968.

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Abstract

We sought to describe the acute results and short- to medium-term durability of transcatheter tricuspid valve-in-valve (TVIV) implantation within surgical bioprostheses among patients with Ebstein anomaly (EA). Cases were identified from a voluntary, multicenter, international registry of 29 institutions that perform TVIV. Demographic, clinical, procedural, and follow-up data were analyzed. Eighty-one patients with EA underwent TVIV from 2008 to 2016. Thirty-four patients (42%) were New York Heart Association (NYHA) class 3/4 at time of TVIV. The most common indication for TVIV was the presence of moderate or severe tricuspid regurgitation (40%). Most patients received a Melody valve (64%). TVIV was ultimately successful in all patients, and there was no procedural mortality. Four patients (5%) developed acute valve thrombosis, 4 patients (5%) developed endocarditis, and 9 patients (11%) developed valve dysfunction not related to thrombosis or endocarditis. Eight patients (10%) underwent reintervention (2 transcatheter, 6 surgical) due to thrombosis (3), endocarditis (2), other valve dysfunction (2), and patient-prosthesis mismatch without valve dysfunction (1). Among 69 patients who were alive without reintervention at latest follow-up, 96% of those with NYHA status reported were class 1/2, a significant improvement from baseline (62% NYHA class 1/2, p <0.001). In conclusion, transcatheter TVIV offers a low-risk, minimally invasive alternative to surgical tricuspid valve re-replacement in patients with EA and a failing tricuspid valve bioprosthesis.

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