Author + information
- Received June 22, 2018
- Revision received August 1, 2018
- Accepted August 1, 2018
- Published online January 16, 2019.
- Rebecca T. Hahn, MDa,∗ (, )
- Isaac George, MDa,
- Susheel K. Kodali, MDa,
- Tamim Nazif, MDa,
- Omar K. Khalique, MDa,
- Deniz Akkoc, BAa,
- Alex Kantor, BAa,
- Torsten P. Vahl, MDa,
- Amisha Patel, MDa,
- Elliott Elias, MDa,
- Vivian Ng, MDa,
- Roberto Spina, MDa,
- Krzysztof Bartus, MDb,
- Poonam Velagapudi, MDb,
- Isaac Wu, MDa,
- Martin Leon, MDa and
- Vinayak Bapat, MDa
- aColumbia University Medical Center/NewYork Presbyterian Hospital, New York, New York
- bDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- ↵∗Address for correspondence:
Dr. Rebecca T. Hahn, Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, New York 10032.
Objectives This study presents a single-site experience of 5 patients with severe tricuspid regurgitation (TR) who underwent implantation of a novel transcatheter tricuspid valve replacement device.
Background Functional TR is the most common etiology of severe TR in the developed world and is associated with unfavorable clinical outcomes. Although numerous transcatheter repair devices are currently in early clinical trials, most result in incomplete degrees of TR reduction and functional improvement.
Methods Transcatheter tricuspid valve replacement was performed in 5 patients with compassionate use of the novel GATE System. All patients had computed tomography transthoracic and transesophageal echocardiographic assessment of the tricuspid valve and right heart anatomy. All patients had symptomatic, massive and/or torrential TR at baseline. All patients had a surgical transatrial approach performed with valve implantation guided by fluoroscopy and intraprocedural transesophageal echocardiography.
Results Baseline characteristics of the patients showed a substantial burden of comorbidities. All patients had successful implantation of the transcatheter valve, with significant reduction of TR to ≤2+. Baseline poor right ventricular (RV) function measured by global longitudinal strain and RV change in pressure divided by change in time were associated with post-implantation RV failure and poor clinical outcomes in this small group. Four of the 5 patients were followed for 3 to 6 months following the initial implantation and showed evidence of RV remodeling, increased cardiac output, and reduction in New York Heart Association functional class.
Conclusions Implantation of a first-generation TTVR device was technically feasible in patients with more than severe TR. Transcatheter tricuspid valve replacement was associated with RV remodeling, increased cardiac output, and improvement in New York Heart Association functional class in most patients. Further studies are needed to refine patient population selection for this device and to determine long-term outcomes.
Drs. Hahn and Bartus are consultants for NaviGATE. Dr. Kodali has been a member of the advisory board for Abbott Vascular, Biotrace Medical, Dura Biotech, and Thubrikar Aortic Valve; has been a consultant for Merrill Lifesciences and Claret Medical; and owns equity in Dura Biotech, Thubrikar Aortic Vale, and Biotrace Medical. Dr. Nazif has been a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Khalique has been a member of the Speakers Bureau for Edwards Lifesciences. Dr. Bapat has been consultant for Medtronic and Edward Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 22, 2018.
- Revision received August 1, 2018.
- Accepted August 1, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.