title: Percutaneous tricuspid valve replacement in congenital and acquired heart disease.
abstract: OBJECTIVE
  This study sought to describe the first human series of percutaneous tricuspid valve replacements in patients with congenital or acquired tricuspid valve (TV) disease.
  
  
  BACKGROUND
  Percutaneous transcatheter heart valve replacement of the ventriculoarterial (aortic, pulmonary) valves is established. Although there are isolated reports of transcatheter atrioventricular heart valve replacement (hybrid and percutaneous), this procedure has been less frequently described; we are aware of no series describing this procedure for TV disease.
  
  
  METHODS
  We approached institutions with significant experience with the Melody percutaneous pulmonary valve (Medtronic, Inc., Minneapolis, Minnesota) to collect data where this valve had been implanted in the tricuspid position. Clinical and procedural data were gathered for 15 patients. Indications for intervention included severe hemodynamic compromise and perceived high surgical risk; all had prior TV surgery and significant stenosis and/or regurgitation of a bioprosthetic TV or a right atrium-to-right ventricle conduit.
  
  
  RESULTS
  Procedural success was achieved in all 15 patients. In patients with predominantly stenosis, mean tricuspid gradient was reduced from 12.9 to 3.9 mm Hg (p < 0.01). In all patients, tricuspid regurgitation was reduced to mild or none. New York Heart Association functional class improved in 12 patients. The only major procedural complication was of third-degree heart block requiring pacemaker insertion in 1 patient. One patient developed endocarditis 2 months after implant, and 1 patient with pre-procedural multiorgan failure did not improve and died 20 days after the procedure. The remaining patients have well-functioning Melody valves in the TV position a median of 4 months after implantation.
  
  
  CONCLUSIONS
  In selected cases, patients with prior TV surgery may be candidates for percutaneous TV replacement.
authors: Royal Prince Alfred Hospital, Sydney, Australia. philipr2@chw.edu.au
authors: Philip A
authors: PA
authors: Roberts
authors: Younes
authors: Y
authors: Boudjemline
authors: John P
authors: JP
authors: Cheatham
authors: Andreas
authors: A
authors: Eicken
authors: Peter
authors: P
authors: Ewert
authors: Doff B
authors: DB
authors: McElhinney
authors: Sharon L
authors: SL
authors: Hill
authors: Felix
authors: F
authors: Berger
authors: Danyal
authors: D
authors: Khan
authors: Dietmar
authors: D
authors: Schranz
authors: John
authors: J
authors: Hess
authors: Michael D
authors: MD
authors: Ezekowitz
authors: David
authors: D
authors: Celermajer
authors: Evan
authors: E
authors: Zahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography / Q000379:methods; D002648:Child; D003251:Constriction, Pathologic; D004452:Echocardiography / Q000379:methods; D004696:Endocarditis; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000473:pathology; D012306:Risk; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*