title: Heterotopic transcatheter tricuspid valve implantation: first-in-man application of a novel approach to tricuspid regurgitation.
abstract: OBJECTIVE
  Transcatheter treatment of heart valve disease is well established today. However, for the treatment of tricuspid regurgitation (TR), no effective catheter-based approach is available. Herein, we report the first human case description of transcatheter treatment of severe TR in a 79-year-old patient with venous congestion and associated non-cardiac diseases. In this patient, surgical treatment had been declined and pharmacological therapy had been ineffective. After ex vivo and animal studies, the treatment of TR was performed by percutaneous caval valve implantation.
  
  
  RESULTS
  In a transcatheter approach through the right femoral vein, a custom-made self-expanding heart valve was implanted into the inferior vena cava (IVC). The device was anchored in the IVC at the cavoatrial junction with the level of the valve aligned immediately above the hepatic inflow and protruding into the right atrium. After deployment, excellent valve function was observed resulting in a marked reduction in caval pressure and an abolition of the ventricular wave in the IVC. Sequential echocardiographic exams over a follow-up period of 8 weeks confirmed continuous device function without paravalvular leakage or remaining venous regurgitation. The patient experienced improved physical capacity and was able to resume off-bed activities. There was no recurrence of right heart failure during follow-up and a partial reduction of ascites. The patient was discharged from hospital into a rehabilitation programme.
  
  
  CONCLUSIONS
  Transcatheter treatment of severe TR by caval valve implantation is feasible resulting in an immediate abolition of IVC regurgitation and mid-term clinical improvement. Thus, in selected non-surgical patients, caval valve implantation may become a therapeutic option to treat venous regurgitation and improve associated non-cardiac diseases. Further confirmatory experience with longer follow-up is required to evaluate the long-term clinical benefit of the procedure as well as potential deleterious effects.
authors.affiliation: Department of Internal Medicine I (Cardiology, Angiology and Intensive Care Medicine), University Heart Center Jena, Erlanger Allee 101, Jena, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lauten
authors.forename: Markus
authors.initials: M
authors.lastname: Ferrari
authors.forename: Khosro
authors.initials: K
authors.lastname: Hekmat
authors.forename: Ruediger
authors.initials: R
authors.lastname: Pfeifer
authors.forename: Gudrun
authors.initials: G
authors.lastname: Dannberg
authors.forename: Andreas
authors.initials: A
authors.lastname: Ragoschke-Schumm
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016042:Transplantation, Heterotopic; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D014682:Vena Cava, Inferior