Device implanted for tricuspid valve replacement: First in United States

Percutaneous interventions use hollow tubes called catheters to reach chambers of the heart rather than opening a patient's chest, and are increasingly used to fix heart valves.

Cardiac surgeon Steven Bolling, M.D., interventional cardiologist Stanley Chetcuti, M.D.; interventional cardiologist Daniel Menees, M.D., and cardiac surgeon Matthew Romano, M.D., successfully completed the procedure Aug. 11.

Because of the less invasive approach, the 47-year-old patient was discharged after only a two-day hospital stay.

"Minimally invasive surgery for tricuspid valve replacement is a new solution for the dilemma of treating valve disease in which repeat surgeries are often needed but problematic," says Bolling, director of the U-M Mitral Valve Clinic. "This was a rewarding result for all of us."

Compared to the explosion of transcatheter aortic valve replacement (TAVR), transcatheter tricuspid valve-in-valve implantation is just beginning.

The U-M cardiac team replaced the patient's diseased heart valve to improve blood flow on the right side of her heart. Tricuspid valve stenosis had caused the valve to narrow. Adding to the complexity, her heart valve had been replaced before using animal tissue.

Catheter-based procedures have allowed many people too old, frail or at high surgical risk to get help for severe heart problems. Testing is underway to use the procedure for other heart valves, including:

• MitraClip -- The U-M is screening patients for the investigational mitra clip device, a less invasive method to treat mitral regurgitation caused by a leaky mitral valve.

• TAVR -- Specialists at the U-M Cardiovascular Center are among the most experienced in the country at performing TAVR, a catheter-based treatment to replace the aortic valve. The U-M's comprehensive program is examining broader use of TAVR for patients at intermediate risk for open heart surgery and testing the next generation of valve systems by Edwards and Medtronic.

• Pulmonary valve -- A national study led by U-M pediatric cardiac surgeon Aimee Armstrong, M.D., showed strong results for non-surgical replacement of the pulmonary valve.