Percutaneous Tricuspid Valve Implantation (PTVI)

Abstract

Tricuspid valve dysfunction may lead to surgical tricuspid valve replacement if a valve plasty is not successful. Usually, in patients with congenital heart disease, a biological valve prosthesis is chosen in tricuspid position, which has a limited durability. Once a repeated tricuspid valve replacement is indicated, percutaneous tricuspid valve implantation (PTVI) is a feasible and safe alternative to repeated cardiac surgery. The previously implanted bioprosthesis serves as a perfect landing zone for the percutaneous valve (valve-in-valve implantation). So far, two commercially available percutaneous valves have been used in tricuspid position, the Melody valve (Medtronic Inc., Minneapolis, MN) and the Edwards Sapien XT/Sapien 3 valves (Edwards Lifesciences LLC, Irvine, CA). Both valves have been described in detail previously and received FDA approval for implantation in pulmonic position (Melody valve and Sapien XT valve). Since until today there is no approval for percutaneous tricuspid valve implantation, this intervention is performed as an off-label procedure, which needs to be discussed with the patients or their guardians. Our own experience in Munich comprises 19 percutaneous tricuspid valve implantations.