Caval Valve Implantation (CAVI): An Emerging Therapy for Treating Severe Tricuspid Regurgitation

Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices.

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Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa428 ◽

2020 ◽

Author(s):

Aidan Sharkey ◽

Ronny Munoz Acuna ◽

Kiran Belani ◽

Ravi K Sharma ◽

Omar Chaudhary ◽

...

Keyword(s):

Medical Therapy ◽

Tricuspid Regurgitation ◽

Surgical Intervention ◽

Symptom Relief ◽

Vena Cava ◽

Case Series ◽

High Morbidity ◽

Severe Tricuspid Regurgitation ◽

Maximal Medical Therapy ◽

Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

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Percutaneous Treatment of Tricuspid Regurgitation

10.5772/intechopen.95799 ◽

2021 ◽

Author(s):

Carlos Minguito-Carazo ◽

Tomás Benito-González ◽

Rodrigo Estévez-Loureiro ◽

Carmen Garrote-Coloma ◽

Julio Echarte-Morales ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Heart Surgery ◽

Ventricular Remodeling ◽

Open Heart Surgery ◽

Unmet Need ◽

Vena Cava ◽

Percutaneous Treatment ◽

Tricuspid Valve Annulus ◽

Valve Implantation

Tricuspid valve regurgitation is one of the most common valvular disorders and moderate to severe tricuspid regurgitation is consistently associated to an increased morbidity and mortality. From an etiopathological perspective, tricuspid regurgitation can be classified in primary, due to the organic disease of any of the valve components, or secondary, as a result of tricuspid valve annulus dilatation, adverse right ventricular remodeling and tricuspid valve leaflet tethering. Despite its poor prognosis, most patients with tricuspid insufficiency are managed conservatively and only those with concomitant left heart valvular disease do finally go surgery in the real-world setting. In fact, outcomes of conventional surgery in patients with isolated tricuspid regurgitation are poor and this approach has not proven yet any survival benefit over stand-alone medical therapy. Given this unmet need, new transcatheter techniques have been developed in the last years, including leaflet plication, percutaneous annuloplasty and valve implantation in either the tricuspid position (orthotopic implantation) or in a different position such as the vena cava (heterotopic implantation). These techniques, with promising outcomes, are seen as an interesting alternative to open-heart surgery given the much lower periprocedural risk.

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Early Stroke Detection in Perioperative Patients: A Simple Educational Intervention and Feasibility Study

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.01.12097 ◽

2021 ◽

Vol 104 (1) ◽

pp. 150-158

Keyword(s):

Neurological Deficit ◽

Heart Surgery ◽

Negative Impact ◽

Open Heart Surgery ◽

Neurological Deficits ◽

Number Needed To Treat ◽

High Morbidity ◽

Neurological Assessment ◽

Post Intervention ◽

Perioperative Stroke

Background: Perioperative stroke is uncommon. However, it carries high morbidity and mortality. Unfortunately, the diagnosis is usually delayed resulting in reduced possibility for therapeutic intervention. Objective: To develop a protocol directed at shortening the time to detect neurological deficits in postoperative patients. Materials and Methods: By using a pre-post intervention design to evaluate the time to stroke recognition in post-open heart surgery patients. The intervention consisted of 1) A new protocol to evaluate new neurological deficits within 14 days after surgery, composed of six items of simple neurological assessment applied by CVT nurses during routine vital sign measurement. 2) An educational program for nurses, patients, and family focusing on postoperative stroke complications. Results: Between January 2014 and October 2015, the authors retrospectively reviewed 27 consecutive patients with acute neurological deficit within 14 days after surgery as the pre-intervention population. Twenty-seven consecutive patients with postoperative neurological deficits were enrolled during a post-intervention period, which was between November 2015 and September 2016. Comparing pre- and post-intervention periods, the authors found that stroke fast track activation was significantly increased from 4/27 (14.80%) to 15/27 (55.60%) (p=0.002). The median (min-max) duration from time last seen normal to first neurological deficit detection was reduced from 690 (19 to 9,190) to 130 (5 to 5,935) minutes (p=0.003). The number needed to treat for early detection when the protocol was used was 2.94. There was an increasing trend to endovascular treatment. Conclusion: Perioperative stroke is rare. However, it has negative impact to postoperative patients’ outcome. A simple protocol for postoperative neurological assessment after cardiac surgery is feasible to detect perioperative stroke. Keywords: Postoperative, In-hospital, Detection, Recognition, Stroke

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Inferior Caval Valve Implantation Versus Optimal Medical Therapy for Severe Tricuspid Regurgitation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.05.019 ◽

2019 ◽

Vol 74 (3) ◽

pp. 473-475 ◽

Cited By ~ 3

Author(s):

Michael Laule ◽

Isabel Mattig ◽

Christoph Schöbel ◽

Fabian Knebel ◽

Alexander Lauten ◽

...

Keyword(s):

Medical Therapy ◽

Tricuspid Regurgitation ◽

Optimal Medical Therapy ◽

Severe Tricuspid Regurgitation ◽

Valve Implantation

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Case report of simultaneous transcatheter mitral valve-in-valve implantation and percutaneous closure of two paravalvular leaks

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz123 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Masahiko Asami ◽

Thomas Pilgrim ◽

Stephan Windecker ◽

Fabien Praz

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Transoesophageal Echocardiography ◽

Paravalvular Leak ◽

Open Heart ◽

Surgical Risk ◽

Significant Difference ◽

Valve In Valve ◽

Valve Implantation

Abstract Background Concomitant structural degeneration of surgical mitral bioprostheses and paravalvular leak (PVL) is rare but potentially fatal. Data pertaining to simultaneous transcatheter mitral valve implantation (TMVI) and percutaneous PVL closure are limited, and the optimal treatment strategy remains undetermined. We report a case of simultaneous TMVI and double percutaneous PVL closure in a patient with a degenerated bioprosthetic mitral valve and associated medial and lateral PVLs. Case summary A 75-year-old woman who underwent combined aortic (Edwards Perimount Magna 19 mm) and mitral (Edwards Perimount Magna 25 mm) surgical valve replacement 6 years ago was referred for treatment of new-onset orthopnoea and severely reduced exercise capacity. Transoesophageal echocardiography revealed severe mitral stenosis and concomitant moderate to severe mitral regurgitation, originating from two PVLs located medial and lateral from the surgical bioprosthesis. Due to high surgical risk, we performed successful transseptal mitral valve-in-valve (ViV) implantation combined with the closure of two PVLs during the same procedure. Discussion Although surgery should be considered as a first-line treatment in this setting, most patients have extremely high or prohibitive surgical risk inherent to repeat open heart surgery. Mitral ViV implantation appears a reasonable treatment option for patients with failed mitral bioprostheses. Furthermore, a recent study of percutaneous PVL closure showed no significant difference in long-term all-cause mortality compared with redo open-heart surgery. Simultaneous TMVI and percutaneous PVL closure appears feasible in selected high-risk patients.

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Reversal of Femoral Vein Pulsatility Due to Severe Tricuspid Regurgitation After Transcatheter Tricuspid Valve-in-Valve Implantation: A “Wave Dissipation” Effect

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.05.104 ◽

2021 ◽

Author(s):

Ana Rita Pereira ◽

Frank van der Kley ◽

Jose M. Montero-Cabezas ◽

Arend de Weger ◽

Victoria Delgado

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Femoral Vein ◽

Wave Dissipation ◽

Severe Tricuspid Regurgitation ◽

Dissipation Effect ◽

Valve In Valve ◽

Valve Implantation

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Evaluation of Complications of Heart Surgery in Children With Congenital Heart Disease at Dena Hospital of Shiraz

Global Journal of Health Science ◽

10.5539/gjhs.v8n5p33 ◽

2015 ◽

Vol 8 (5) ◽

pp. 33 ◽

Cited By ~ 2

Author(s):

Maryam Mirzaei ◽

Samaneh Mirzaei ◽

Elham Sepahvand ◽

Afifeh Rahmanian Koshkaki ◽

Marzieh Kargar Jahromi

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Heart Surgery ◽

Open Heart Surgery ◽

Vascular Complications ◽

Congenital Heart Surgery ◽

Morbidity And Mortality ◽

High Morbidity ◽

Cross Sectional

INTRODUCTION: Today, with progress in the field of congenital heart surgery, different complicated actions are done in children. These actions may be associated with several complications, especially open heart surgery in which the cardiopulmonary bypass (CPB) is used. Serious complications can be caused high morbidity and mortality rates. Present study has been performed to determine the incidence of morbidity and mortality in cardiac surgery in children. METHOD: In a cross-sectional retrospective, records of 203 patients undergoing surgery for congenital heart disease in Dena hospital during 2013-2015 were reviewed for incidence of complications. Data was analyzed by using descriptive and analytical statistics and using SPSS version 18. RESULTS: The mean age of samples was 3/65±4/47 years. The majority of samples (73/8%) were undergoing open surgery. The overall adverse cardiovascular complications were respectively, renal complications (44/3%), lung (40/3%), anemia (35/9%), heart (34/4%), gastrointestinal (17/2%), brain (14/2%), need for re-intubation of the trachea 11/3%), infection (7/8%) required reoperation (5/9%) and vascular complications (1/4%). CONCLUSION: High incidence of complications after congenital heart surgery makes necessary attention to complications and their treatment after surgery. It is necessary to apply the measures and careful monitoring of patients to minimize these effects.

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Gastrointestinal Complications Following Cardiac Surgery.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i1.33 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Alfred Ibrahimi ◽

Saimir Kuçi ◽

Ervin Bejko ◽

Stavri Llazo ◽

Jonela Burimi ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Intestinal Ischemia ◽

Heart Surgery ◽

Open Heart Surgery ◽

Morbidity And Mortality ◽

Gastrointestinal Complication ◽

High Morbidity ◽

Low Cardiac Output Syndrome ◽

Gastrointestinal Complications

Purpose: gastrointestinal complication (GIC) following open heart surgery usually are rare but with high morbidity and mortality. The aim of this study was to see the outcome of these patients after complication, compared with a similar study found in literature. Identifying risk factors preoperatively and postoperatively in our patient’s series, for GIC.Materials and methods: Between January 2012 and December 2017 from 1990 operated cardiac patient 34 of them developed GIC, presenting gastro duodenal bleeding due to active ulcer, liver failure, pancreatitis, cholecystitis, or intestinal ischemia. We performed a retrospective analysis.Results: From all consecutive patient only 1.7 % developed GIC. Mortality rate was 55.8%, especially 100 % mortality in intestinal ischemia patient. Regarding risk factors, those were the same found in other similar study (age, atherosclerosis disease, by pass time, postoperative ARF, Low cardiac output syndrome.)Conclusion: GIC after cardiac surgery are rare but when it happens the mortality is very high not even of late diagnosis. In ages patients, diabetes, long by pass time, long hypoperfusion state. It is recommended to be alert for GIC for detection in early phase, and for reducing as much as possible morbidity and mortality.

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Percutaneous retrieval of a partially flared Melody valve

Cardiology in the Young ◽

10.1017/s1047951117003018 ◽

2018 ◽

Vol 28 (5) ◽

pp. 753-755

Author(s):

Katarzyna Gendera ◽

Peter Ewert ◽

Andreas Eicken

Keyword(s):

Heart Surgery ◽

Pulmonary Valve ◽

Jugular Vein ◽

Open Heart Surgery ◽

Open Heart ◽

Melody Valve ◽

Percutaneous Pulmonary Valve Implantation ◽

The Right ◽

Valve Implantation ◽

Percutaneous Pulmonary Valve

AbstractWe report on successful endovascular retrieval of an accidentally flared Melody valve in an adult patient with an indication for percutaneous pulmonary valve implantation. The Melody valve was removed through a 24 F sheath, introduced via the right jugular vein, and the urgent open-heart surgery was avoided.

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