Author + information
- Hans R. Figulla1,
- Torsten Doenst2,
- Marcus Franz2,
- Ali Hamadanchi3,
- Daniel Kretzschmar3 and
- Alexander Lauten2
Despite the recent advances in interventional treatment of heart valve disease, no transcatheter approach is established for severe tricuspid regurgitation (TR). Single valve implantation into the inferior vena cava (IVC) has been suggested, which however only partially resolves the hemodynamic sequelae of TR. After extensive preclinical evaluation, we herein report the first human case of bi-caval self-expanding valve implantation (CAVI) in the superior (SVC) and inferior vena cava.
CAVI was performed in a 83-year-old patient with severe TR, chronic right heart failure and congestive hepatopathy. Two self-expanding pericardial valves were custom-made to fit to the anticipated implantation zones in the caval veins of this patient. Both devices were implanted under flouroscopy using a 27F-catheter and deployed at the level of the cavo-atrial junction of the SVC and the IVC. To protect the hepatic veins from backward flow, the inferior valve was aligned just above the hepatic vein inflow and deployed with the valve protruding into the right atrium (RA).
After deployment and during 3-month follow-up excellent valve function was observed. The procedure resulted in a marked reduction of the pressure in the SVC and IVC from 27/14mmHg and 28/15mmHg to 21/7mmHg and 13/6mmHg at 3 month, respectively. After implantation symptoms of right heart failure resolved and did not recurr during follow-up and synthetic liver function recovered. The patients physical capacity improved with an increase in distance covered in 6-minute-walk-test from 20m before implantation to 200m at 3 month.
In this first-in-man experience, transcatheter CAVI proved feasible and resulted in persistent hemodynamic and clinical improvement. Further confirmatory experience with longer follow-up is required to evaluate the clinical benefit of the procedure.