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Heterotopic valve implantation into the caval veins has been suggested to treat venous congestion in severe TR. We report our experience with this approach from basic preclinical studies to the first human treatment.
Methods and Results
Proof-of-concept studies were performed in a sheep model. Following the induction of TR, two valves were implanted into the superior and inferior caval (IVC) vein resulting in a significant decrease of the ventricular wave ('v'-wave) from 16.2±2.33 to 13.9±2.97mmHg and a significant increase of cardiac output from 2.9±1.16l to 4.20±0.84l/min. Valve function was documented during 6 month follow-up. Autopsy results verified device position and function in all successfully implanted animals. Based on these promising results, the first-in-man concept application was performed for compassionate treatment in an inoperable 79-year-old patient (EuroScore 29.7%, 3 previous heart procedures). In this patient a self-expanding pericardial tissue valve was implanted in the IVC and anchored at the cavo-atrial junction immediately above the hepatic vein inflow. After deployment, excellent device function and valvular competence with full systolic valve closure was confirmed. Hemodynamics confirmed a nearly abolished v-wave in the IVC from 29/19 to 19/12mmHg and a decrease of mean pressure from 19 to 16mmHg. Valve function remained excellent during the first 8 weeks of follow-up. The patient experienced improved physical capacity and was able to resume off-bed acitivities. There was no recurrence of RV failure during follow-up and a partial reduction of ascites. The patient was discharged from hospital into a rehabilitation program.
Transcatheter caval valve implantation for treatment of severe TR is feasible resulting in an immediate abolition of IVC regurgitation with midterm clinical improvement. Thus, in selected non-surgical patients this interventional concept may become a therapeutic option to treat venous regurgitation and improve hepatic congestion. Further confirmatory experience with longer follow-up is required to evaluate the long-term clinical benefit of the procedure as well as potential deleterious effects.
ACC Moderated Poster Contributions
McCormick Place South, Hall A
Sunday, March 25, 2012, 11:00 a.m.-Noon
Session Title: Valvular Heart Disease: Controversies and Innovations
Abstract Category: 11. Valvular Heart Disease: Therapy
Presentation Number: 1152-342
- 2012 American College of Cardiology Foundation