MedWire News: Severe tricuspid regurgitation (TR) may be successfully treated using a transcatheter approach, according to a first-in-man report published in the European Heart Journal.
The procedure was conducted by Hans Figulla's team at the University Heart Center in Jena, Germany. The patient was a 79-year-old woman with severe TR, venous congestion, and associated noncardiac disease. She was unwilling to undergo surgical treatment and pharmacologic treatment had been ineffective.
In the light of promising findings from ex vivo and animal studies, Figulla's team decided to manage the patient with percutaneous caval valve implantation.
As described in their report, they inserted a custom-made self-expanding heart valve via the right femoral vein. The valve was implanted into the inferior vena cava and was anchored in place at the cavoatrial junction, aligned immediately above the hepatic inflow and protruding into the right atrium.
The researchers report that the device functioned well as soon as it was deployed. Transesophageal echocardiography confirmed full systolic closing and diastolic opening of the leaflets, without any sign of paravalvular regurgitation.
Furthermore, hemodynamic measurements revealed a marked reduction in caval pressure and an abolition of the ventricular wave in the inferior vena cava.
The device continued to function well over a follow-up period of 8 weeks and the patient experienced an improvement in her physical capacity. She had a partial resolution of ascites and was discharged to a rehabilitation program 3 weeks after the procedure.
"Thus, in selected non-surgical patients, caval valve implantation may become a therapeutic option to treat venous regurgitation and improve associated noncardiac diseases," say Figulla et al.
"Further studies are required to evaluate the clinical benefit of the procedure during long-term follow-up," they add.
The team concludes that "although the treatment offers a high likelihood for clinical improvement in this severely ill subgroup of patients, the costs involved for this type of procedure should be taken into account and carefully weighed against the clinical benefit."
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