Trans-jugular Tricuspid Valve-in-a-ring Implantation: Experimental Feasibility Study In Short-term Survival Porcine Model
Thang Duc Vu, Duc Viet Nguyen, Ervin Marquez Ocampo, Hannah Qi-Hui Tan, Diyana Ja'afar, Mohamed Alaa, Maria Tsopanomichalou Gklotsou, Lian Kah Ti, Theodoros Kofidis.
National University of Singapore, Singapore, Singapore.
Background: Tricuspid valve (TV) dysfunction is “non-forgotten” anymore, as it is the subject of renewed and increasing interest. Frail patients with secondary TV regurgitation due to left-sided heart lesions typically suffer RV dysfunction. The re-do TV surgery is intolerable and carries an operative mortality risk up to 25%. The targeted patients are vast with limited surgical options. The continuum of transcatheter applications reshaped the map of TV surgery. We advanced the feasibility of replacing the TV with an experimental study on porcine model via a novel trans-jugular approach for valve-in-a-ring TV implantation (TVIR).Methods: Conventional on-pump TV repair with cardiac arrest initially performed via sternotomy using size (30) Medtronic® CG-FUTURE™ ring in six pigs (n=6). After 4 weeks, TVIR followed via right trans-jugular approach using size (29) Edward® SAPIEN XT™ valve under fluoroscopic guidance, valvular competency ensured by echocardiography and ventriculography on different time intervals (first-day after TV ring repair, 4 weeks later pre-TVIR, and 3 weeks after TVIR).Results: Standard TV ring repair was successfully performed, uneventfully in all animals. Transvalvular pressure gradients (Pmax 2.42 ± 0.7 mmHg; Pmean 1.3 ± 0.6 mmHg) and transvalvular flow velocities (Vmax 82 ± 10.4 cm/s; Vmean 65.4 ± 21 cm/s) were within normal ranges. All TVIRs were successfully implanted through the prosthetic ring in acceptable position. Cardiac CT and echocardiography confirmed the integrity of adjacent structures post-TVIR. Right ventriculogram demonstrated mild paravalvular leak in one animal (16%). Pressure gradients across the TVIR were (Pmax 4.7 ± 1.6 mmHg; Pmean 2.7 ± 0.8 mmHg) and flow velocities were (Vmax 105 ± 31 cm/s; Vmean 81 ± 16 cm/s) with a systolic dominance of hepatic venous flow and normal (RA/RV/IVC) sizes ratio. TVIR procedural time from percutaneous right jugular insertion, valve deployment to sheath removal was 20.5 ± 4 min.Conclusion: We effectively performed TVIR within prosthetic ring under fluoroscopic guidance via a novel trans-jugular approach in markedly short time. This technique proved to be safe and could offer a robust therapeutic option for high-risk TV dysfunction patients. 
LEGEND: (A, B) 3D-cardiac CT; (C, D, E) 2D-contrast CT; (F) Rt. Ventriculogram; (G, H) macroscopic examination post-TVIR
Back to 2018 ePosters