Single-Center Experience with Catheter-Based Tricuspid Valve Replacement with NaviGate Bioprosthesis for Tricuspid Regurgitation

Objectives: Percutaneous/minimally invasive procedures are an interesting alternative to conventional surgery for selected high-risk patients with primary and secondary tricuspid regurgitations (TRs). NaviGate valved stent has been designed to treat native TR by means of a catheter-based valve replacement.

Methods: Here, we present our single-center experience with NaviGate implantation. The procedure was successfully performed in four consecutive patients. Patient 1 was 64-year-old man with functional tricuspid regurgitation; patient 2 is a 76-year-old man with iatrogenic tricuspid valve regurgitation (pacemaker extraction for infective endocarditis); patient 3 was a 53-year-old woman with tricuspid valve rheumatic disease causing combined stenoinsufficiency; patient 4 was a 72-year-old woman with secondary TR (annulus enlargement, atrial fibrillation). All patients had clinical sign and symptoms of right heart failure despite optimized medical therapy.

Results: The NaviGate prostheses (54 mm for patient 1, 40 mm for patient 2, 44 mm for patient 3, and 40 mm for patient 4) were successfully implanted in all the four cases in hybrid room, with anterolateral right minithoracotomy, under general anesthesia and with intraoperative transesophageal guidance. In all cases, right atrial access was safe and there were no intraprocedural hemodynamic instability, coronary obstruction, or rhythm disturbance. After valve deployment, there was no anterograde gradient in all cases and no severe residual TR. There were no further complications during hospitalization.

Conclusion: In our preliminary experience, catheter-based tricuspid valve replacement with the NaviGate device represents a valuable alternative to conventional surgery in high-risk patients and is feasible and safe in different anatomical settings.