First‐in‐human transcatheter pledget‐assisted suture tricuspid annuloplasty for severe tricuspid insufficiency

Objectives We report the first pledget‐assisted suture tricuspid annuloplasty (PASTA) in a patient with torrential tricuspid regurgitation (TR). Background Tricuspid valve regurgitation is a common malignant disease with no commercially available transcatheter therapy. PASTA is a “percutaneous surgical” procedure using pledgeted sutures to create a double‐orifice tricuspid valve. Methods An 83‐year‐old man had end‐stage TR caused by a defibrillator lead. He consented to undergo PASTA on a compassionate basis. A double‐orifice valve was created with pledgeted sutures from percutaneous right ventricular apical access. Results TR was reduced from torrential to trace. The vena contracta reduced to from 23 to 1 mm and annular area reduced from 1817 to 782 mm 2 . However, the annulus dehisced and required closure with a percutaneous nitinol plug. The patient was discharged home and was alive 6 months later but with persistent symptoms. Conclusions The anatomy of a double‐orifice valve can eliminate TR but a better solution is required to avoid excessive suture tension on annular tissue.