1. 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

2. Disclosures
Founder and Shareholder:
Avidal
JenaValve
Occlutech

3. 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

4. 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)

5. 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)

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

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

8. 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

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

10. 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

11. 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 cm below
right atrium

12. 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 cm above
right atrium

13. 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

14. Hemodynamics – Cardiac Output (n=9)* *

22. 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 )