title: Long-term follow-up after trans-catheter tricuspid valve-in-valve replacement with balloon-expandable aortic valves.
abstract: BACKGROUND
  Transcatheter tricuspid VIV replacement has been proposed as a feasible option for high-risk patients with previous tricuspid valve replacement that undergo valve degeneration causing refractory heart failure. However, little is known about the long-term outcome of patients treated with transcatheter tricuspid VIV. We evaluate the safety of transcatheter tricuspid valve-in-valve (VIV) replacement by using balloon-expandable aortic valve stents and the long-term follow-up.
  
  
  RESULTS
  From January 2013 to March 2016, 4 patients underwent transcatheter tricuspid VIV in our center using balloon-expandable Edwards Sapien-XT and Sapien-3 valves. In all cases the procedure succeeded with significant improvement of the tricuspid valve area (from 0.98±0.29cm2to 3.1±0.45cm2, p=0.005), right atrial pressure (from 21±7.78mmHg to 8.5±2.51mmHg, p=0.025) and mean trans-valvular gradient (from 11.5±4mmHg to 3.32±1.28mmHg, p=0.02). Three out of 4 patients presented a follow up longer than 2.5years. At median follow up of 32months (range 9-47months) all patients were alive and presented with NYHA class I-II. Only one patient, who presented impaired right ventricular function at baseline, experienced re-hospitalization during the follow-up time. Echocardiographic assessment at long-term disclosed a well-maintained hemodynamic performance with low trans-valvular gradients and no significant valvular regurgitation in all cases.
  
  
  CONCLUSIONS
  In our experience, trans-catheter tricuspid VIV demonstrated good long-term results in terms of valve performance and functional class improvement at 32months from intervention.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scarsini
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Lunardi
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pesarini
authors.affiliation: GVM Research Group, Cotignola, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.affiliation: Ospedale della Trinità, Fossano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Ferrero
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Italy. Electronic address: flavio.ribichini@univr.it.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design / Q000379:methods; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
keywords: Structural heart interventions; Trans-catheter tricuspid valve replacement; Tricuspid valve; Valve-in-valve