Percutaneous valve-in-ring procedure for the management of failed tricuspid annuloplasty

Abstract

To the Editor, Over the last few years we have become aware of the adverse impact of tricuspid regurgitation on morbidity (worse quality of life, hospital admissions…) and mortality with the corresponding increase in the number of interventions performed on the tricuspid valve both surgically and percutaneously.1,2 From the surgical point of view, the most widely used technique for the management of tricuspid valve disease is repair with an annuloplasty to reduce the size of the ring and facilitate leaflet coaptation, usually with incomplete rings, in an attempt to spare the septal conduction system. Short-term results are satisfactory in most cases but according to the series published so far, up to 25% of the patients show moderate or severe regurgitation at 5 years. Overall, we are talking about patients of great complexity, multiple comorbidities, and several prior cardiac surgeries with the corresponding surgical risk, which is why the development of percutaneous coronary intervention techniques may be a great ally. Currently the treatment of tricuspid valve dysfunction through valve-in-valve procedures is the percutaneous treatment of the tricuspid valve for which we have more and most successful experience. The percutaneous implantation of valves in dysfunctional rings are usually procedures with a series of difficulties...