Transcatheter Caval Valve Implantation For Tricuspid Valve Regurgitation; A New Frontier
Seyed Hossein Aalaei-Andabili, Anthony Bavry, Hussam Hawamdeh, Eric Jeng, George Arnaoutakis, Thomas Beaver.
University of Florida, Gainesville, FL, USA.
Background: Severe tricuspid valve regurgitation (TR) leads to decreased cardiac output and devastating functional incapacity. Transcatheter aortic valve options are limited for the tricuspid valve; however, novel technology allows treatment of the upstream effects of severe TR by placing a transcatheter valve into the stented suprahepatic inferior vena cava (IVC). We report transcatheter valve implantation into the dilated IVC of patients with end stage severe tricuspid valve regurgitation. Methods: From September 2018 to October 2019, 4 inoperable patients with severe tricuspid valve regurgitation who had failed medical treatment underwent percutaneous caval valve implantation (CAVI). Severity of tricuspid regurgitation was confirmed by intra-operative transesophageal echocardiography. Two Z-stents (Cook, Inc., Bloomington, IN) were placed in the suprahepatic IVC and then a transcatheter valve was deployed within the stented IVC just above the hepatic vein without rapid pacing. Results: Four patients, 1 female and 3 males with meanąSD age of 77.2ą7.3 years were included. The procedure was successfully performed in all 4 patients (100%) employing a 29 mm SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA). No complications occurred during or after the procedure. Within 30-days, tricuspid valve regurgitation improved from severe to mild-moderate in 2 patients. Among patients with improved TR, ejection fraction increased from 55-60% to 65-70%. No patient had readmission within 30-days. Conclusions: Percutaneous caval valve implantation (CAVI) is feasible with zero morbidity and can be considered as a palliative measure in patients with severe tricuspid valve regurgitation. CAVI can improve TR and cardiac output and potentially improves diuretic responsiveness by lowering venous hypertension. Further studies with a larger sample size and longer-term follow up is warranted to evaluate the efficacy and durability of CAVI. 
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