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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Percutaneous tricuspid valve intervention – early experience in a single centre
Session:
Posters (Sessão 6 - Écran 8) - Intervenção Coronária e Estrutural 5 - Intervenção Valvular
Speaker:
Alexandra Castelo
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Alexandra Castelo; Duarte Cacela; Ruben Ramos; António Fiarresga; Luísa Branco; Ana Galrinho; Pedro Brás; Vera Ferreira; Isabel Cardoso; Ana Rita Teixeira; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Tricuspid valve pathology is associated with significant morbidity and mortality and surgical approach is not always an option. New percutaneous interventions are being developed to treat these patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Purpose</u>: To describe our early experience and results with percutaneous tricuspid valve intervention.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: Retrospective analysis of patients (P) submitted to percutaneous tricuspid intervention between 2018 and 2021 in a tertiary center. Baseline and procedural characteristics and outcomes were collected. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results</u>: 8P (62.5% female) were included, mean age 73 ± 10 years. All P had comorbidities (hypertension 75%, dyslipidemia 62.5%, previous stroke 37.5%, atrial fibrillation 100%). 5P had previous valvular surgery (1 with tricuspid intervention with a bioprosthesis). A device was implanted in 6P (5 pacemakers and 1 defibrillator). All P were taking diuretics (8P furosemide, mean dose 85mg, 4P spironolactone, mean dose 25mg, 1P metolazone 5mg) and all of them were under oral anticoagulation. 8P were in NYHA class 2 or 3, 7P had peripheral edema, 3P had ascites and 3P had previous hospital admissions for heart failure. On echocardiography 6P had right ventricle dilation, mean TAPSE was 17mm and PASP 51mmHg. 1P had tricuspid bioprosthesis disfunction, with mean gradient 13mmHg and moderate insufficiency. All other patients had severe or torrential tricuspid insufficiency (6 due to annulus dilation and 1 lead induced). Mean euroscore II was 6.5 ± 5.9%. 4P were submitted to TricValve ® implantation (1 with an inferior vena cava valve that tilted into the right atrium, with paravalvular leak). 3P were submitted to clip implantation (1 with Mitraclip ® and 2 with Triclip ®), one with 2 clips implanted and the other two with one clip, all with a reduction of ≥2 grades of tricuspid insufficiency. One P was submitted to valve-in-valve implantation, with an end result without any residual insufficiency and a mean gradient of 3.6mmHg. All the procedures were done under general anesthesia, with intraprocedural transesophageal echocardiography. A femoral vein route was used in all P, with one access complication (arterio-venous fistula, with surgical correction). After the procedures 1P died during the hospital stay (late tamponade and, weeks later, multi organ failure) and 1P died 4 months later, with septic shock. There were no other complications related to the procedures. There were no hospital admissions for heart failure. Excluding the patient with early complications, all patients had ≥1 NYHA class improvement, peripheral edema and ascites resolution and diuretic dose reduction during at least 1month follow up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u>: Tricuspid valve pathology is associated with high morbidity and patients are frequently considered inoperable. Percutaneous interventions in selected patients are feasible and associated with few complications and significant clinical improvement.</span></span></p>
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