Tricuspid Valve Implantation via Femoral Access Achieved For First Time

Highlights

• A surgical team successfully implanted a tricusipid using femoral access in a less invasive procedure than surgery.
• The patient reported improved NYHA functional class, improved six-minute walking distance, and quality of life.
• The researchers think this could be a good option for patients who are risk-averse to surgery.

A surgical team in Toronto has succeeded in the world’s first minimally-invasive tricuspid valve replacement, according to a new paper.

The interventional team implanted an EVOQUE tricuspid valve (Edwards Life Sciences) through the femoral vein in his leg (rather than the typical implantation method of open hart surgery or a thoractomy (incision along the patient’s ribs). The common but more invasive procedures often carry additional risk for older and frailer patients.

“Doing tricuspid valve replacements through the femoral approach is a game changer as it opens up treatment options for patients with heart failure who are too sick to undergo surgery, or are not good candidates for tricuspid clipping,” said Dr. Neil Fam, an interventional cardiologist and the Director of Interventional Cardiology and Cardiac Catheterization Labs at St. Michael’s, said in a press release.  “Going through the femoral vein means the risk of complications is dramatically lower.”

According to the correspondence in JACC: Cardiovascular Interventions, the patient was a 75-year-old man with NYHA class III dyspnea, edema, and fatigue. He had prior coronary artery bypass graft (CABG) and also had atrial fibrillation.

“The 28F EVOQUE system was advanced across the tricuspid valve via the right femoral vein over a guidewire,” the authors wrote. “Under transesophageal echocardiographic and fluoroscopic guidance, a 48-mm EVOQUE valve was implanted with mild paravalvular regurgitation in the anteroseptal commissure and mean gradient of 2 mm Hg.”

The researchers reported that the patient had “excellent” clinical response and was discharged after receiving anticoagulation. The patient’s NYHA status improved from class III to class I at six months, and had reduced diuretic requirements, increased six-minute walk distance, and improved quality of life as assessed with the Minnesota Living With Heart Failure Questionnaire.

“Further studies are needed to determine optimal patient selection and the impact of long-term clinical outcomes,” the authors concluded.