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First‐in‐human transcatheter pledget‐assisted suture tricuspid annuloplasty for severe tricuspid insufficiency
Author(s) -
Greenbaum Adam B.,
Khan Jaffar M.,
Rogers Toby,
Babaliaros Vasilis C.,
Eng Marvin H. K.,
Wang Dee Dee,
Paone Gaetano,
Lederman Robert J.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28955
Subject(s) - medicine , regurgitation (circulation) , percutaneous , fibrous joint , surgery , tricuspid valve , cardiology , tricuspid valve insufficiency , 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.