Hans R. Figulla MD,PhD University Heart Center, Jena, Germany Heterotopic Replacement of the Tricuspide Valve A Novel Percutaneous Technique Hans R. Figulla MD,PhD University Heart Center, Jena, Germany

Disclosures Founder and Shareholder: Avidal JenaValve Occlutech

Epidemiology and Current Therapy of Tricuspid Regurgitation: TR functional in 70-85% of all patients Increased right ventricular afterload leading to RV and TV dilatation TR does not resolve with correction of underlying left heart disease Progressive disease leading to right heart failure and secondary dysfunction of liver, interstine and kidneys by increased venous pressure

Epidemiology and Current Therapy of Tricuspid Regurgitation: Combined surgery with mitral- or aortic valve Operative Mortality up to 22% (Filsoufi et al. Mt Sinai J Med. 2006; 73:874-9)

Epidemiology and Current Therapy of Tricuspid Regurgitation: Combined surgery with mitral- or aortic valve Operative Mortality up to 22% (Filsoufi et al. Mt Sinai J Med. 2006; 73:874-9)

Concept of Orthotopic Stent Valve Implantation Limitations: Challenge of stent positioning and fixation Risk of myocardial trauma by stent valve Paravalvular leakage

Concept of Heterotopic Valve Implantation Implantation of valved stents in central venous position to reduce venous congestion

Methods- Heterotopic Valve Implantation for Treatment of TR Sheep Model of Acute TR: Cutting of Leaflets and Chordae by wire blade all procedures performed under flouroscopy in Hybrid -OR with monoplane angiographic system and transesophageal echo

Methods- Heterotopic Valve Implantation for Treatment of TR Angiographic Evaluation Contrasting of right atrium and inferior vena cava after contrast injection into RV

Methods- Heterotopic Valve Implantation for Treatment of TR Implantation Device: Biological valve fixed in paraformal- dehyde Self-expanding nitinol stent of 26mm and 28mm size Implantation catheter

Methods- Heterotopic Valve Implantation for Treatment of TR Valve Implantation in Inferior Vena Cava Step 1: angiographic visualization of IVC Step 2: introduction of 21F- Catheter from right jugular vein and valve deployment in IVC 1.0-1.5cm below right atrium

Methods- Heterotopic Valve Implantation for Treatment of TR Valve Implantation in Superior Vena Cava Step 1: angiographic visualization of SVC Step 2: introduction of 21F- Catheter from right jugular vein and valve deployment in SVC 1.0-1.5cm above right atrium

Acute Stud Severe destruction of TV in 9/ sheep Successful deployment of all IVC-valve and 8 SVC- valves in intended position, intact valve function of all valves by gross evaluation No macroscopic injury/ perforation of central veins or right atrium by stent or implantation catheter No obvious obstruction of coronary sinus

Hemodynamics – Cardiac Output (n=9) * *

animal model and patients Conclusions heterotopic valve implantation is technically feasable in the animal model and patients demonstration of function and acute hemodynamic effects of heterotopic valves in acute TR Open Questions Long term hemodyn. consequences ( pressure load RA, SVC )