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Catheter Cardiovasc Interv. 2019 Feb 27. doi: 10.1002/ccd.28170. [Epub ahead of print]

Transcatheter tricuspid valve-in-valve replacement: Making it simpler.

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Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, Paris, France.


Transcatheter tricuspid valve-in-valve replacement (TTVR) represents an attractive therapeutic option in very high surgical risk patients with degenerated tricuspid bioprostheses. However, the procedural management of these patients might be challenging due to their comorbidities, long lasting heart valve disease and the presence of left-sided mechanical prostheses. Thus, a more "minimally disruptive" procedure would have several potential benefits in such a frail population. We present the cases of four patients admitted for congestive heart failure due to severe degeneration of their tricuspid bioprostheses who were treated with a minimalist TTVR. The protocol combined continuation of the oral anticoagulant treatment with no bridging therapy, the use of a single venous access with local anesthesia, rapid pacing via the stiff right ventricular wire, and transthoracic echocardiographic guidance and assessment, with no need for contrast injection. Our protocol aims at simplifying the TTVR procedure and might be a useful tool to avoid procedural complications and reduce hospital stay.


oral anticoagulation; transcatheter tricuspid replacement; valve in valve


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