The Hemodynamics and Interventional Cardiology Unit of the Cardiology Service of the Bellvitge University Hospital implanted last December, for the first time in the world, a percutaneous double heart valve prosthesis system to a patient with a transplanted heart who suffered a severe tricuspid regurgitation.
The 67-year-old patient received a heart transplant 21 years ago at the Bellvitge University Hospital and, despite the fact that the organ has remained structurally healthy during all these years, he has eventually developed a dilation problem of the tricuspid valve annulus, which has caused a lack of closure of the valve leaflets, causing severe tricuspid regurgitation.
The tricuspid valve is located between the right atrium and the right ventricle, and its role is to prevent the backward movement of blood from the ventricle to the atrium during the contraction of the heart (systole). Its malfunction causes part of the blood to return improperly to the atrium instead of being sent to the pulmonary artery, a dysfunction that affects the entire circulatory system and can lead to liver cirrhosis or kidney failure.
Unlike the normal heart, in which tricuspid valve disease is rare, in transplanted patients tricuspid regurgitation is the most important valvular disease, with a frequency ranging from 20% to 60% of cases when survival is long.
Until now, valvular pathologies in transplanted hearts have been treated only with open surgery. Different types of treatments have been applied, including the placement of rings or valve prostheses. Added to the higher risk of complications that open surgery always involves, is the fact that these are patients have already undergone at least one major surgery such as a transplant. Therefore, the risk of mortality with this approach reaches between 10 and 20%.
Now, for the first time in the world, the Bellvitge University Hospital has carried out this type of treatment to a transplanted heart through percutaneous intervention. Percutaneous cardiology interventionism has undergone spectacular development in recent decades by allowing the introduction of catheters and other devices through the blood vessels, in a minimally invasive way, by means of a small puncture. This approach is already well established in procedures such as unblocking the artery in the event of myocardial infarction or angina pectoris (coronary angioplasty), but it also allows treating a significant and growing number of other heart diseases, including valvular disease.
In this case, cardiologists from the Bellvitge University Hospital have introduced a TricValve device through percutaneous intervention. TricValve is a recently developed new type of prosthesis that has already been placed in non-transplanted hearts. It consists of two valves that are located in the upper and lower vena cava, the two vessels that supply deoxygenated blood to the right atrium of the heart. Once in place, these prostheses perform the function of preventing the return of blood that the tricuspid valve cannot perform correctly.
The implantation carried out at the Bellvitge University Hospital was successful and the patient was discharged after 3 days.
This advance has been possible because the Heart Area of the Bellvitge University Hospital combines extensive experience and leadership both in percutaneous interventionism - it has the highest interventionist activity in Spain - and in transplants, with a level of excellence endorsed by the highest accreditations granted by the Spanish Society of Cardiology.
Dr. Joan Antoni Gómez Hospital, head of the Cardiac Hemodynamics and Interventional Cardiology section of the Bellvitge University Hospital, says that the tricuspid valve pathology "has been relegated in relation to other valvular pathologies" but that "it's not an uncommon problem in transplanted patients that reduces their quality and life expectancy, and had to be given a better response ”.
Gómez Hospital is convinced that this first intervention will be the starting point "to treat more transplanted patients through percutaneous intervention". On the other hand, this will also be more necessary due to the growing number of transplanted patients and increased survival time.