by Health Editorial Staff
The so-called “forgotten valve” can be replaced with a prosthesis without opening the chest. Tricuspid insufficiency is a disabling disease with a high risk of mortality: it affects women and the elderly more
The first operation in Italy to replace the tricuspid valve via catheter was performed at the Monzino Cardiology Center in Milan, conducted by the team led by Federico De Marco, director of the Valvular and Structural Interventional Cardiology Unit. “Patient zero” was discharged from hospital after three days and, more than a week after the operation, she is well. Important news for patients with tricuspid insufficiency who, despite having a disabling disease with a high risk of mortality, until yesterday did not receive adequate care or were not even treated at all: the tricuspid is in fact called the “forgotten valve”.
Complex anatomy
When the tricuspid becomes ill, blood regurgitation is created, a condition which, in the initial stages, is detected in 70-90% of the population who undergoes an echocardiogram. While negligible forms of regurgitation also affect healthy individuals, the more serious forms have a greater incidence in women and increase with advancing age. On average, 4% of people over 75 have a clinically significant form of regurgitation. However, it is estimated that over 90% of people with severe forms of regurgitation are not offered any form of treatment. The tricuspid valve is difficult to treat due to its complex anatomy and its difficult-to-access location on the heart. The transcatheter valve replacement system applied to the Monzino was designed to solve these problems. The system – called “Evoque” – is composed of a nitinol structure (a self-expanding elastic metal), an intra-annular tissue band and flaps of animal pericardial tissue, equivalent to that of traditional heart valves.
International study
It is implanted by inserting a catheter into the femoral vein which pushes the prosthesis up to the heart. The release is guided by ultrasound and the prosthesis attaches using small teeth to the flaps and against the valve ring, eliminating regurgitation and restoring the normal function of the tricuspid, preventing the blood from overloading the body’s veins. The Evoque facility at Monzino is the first in our country, but it is based on the experience and data of the international TRISCEND II study, which recruited 150 patients worldwide. The study evaluated the safety and effectiveness of Evoque in combination with the best available drug therapy, compared to drug treatment alone. The data demonstrate that in the first 150 patients treated, all with severe tricuspid regurgitation, the system allowed successful valve replacement in 95.8 percent of cases, highlighting the superiority of this system compared to pharmacological therapy alone. Excellent results have also been demonstrated in terms of improvement in quality of life six months after the implant.
Multidisciplinary team
Patients with severe tricuspid regurgitation, in addition to suffering from disabling and debilitating symptoms linked to venous overload – such as liver and kidney problems, shortness of breath, widespread edema and swelling – are often forced to frequent hospital admissions for heart failure. «We are finally able to effectively treat tricuspid valve disease without having to subject the patient to open heart surgery, that is, without opening the chest and without stopping the heart. The results are surprising: in advanced stages of the disease the tricuspid prosthesis allows regurgitation to be completely eliminated – commented De Marco -. It is no coincidence that an operation of this kind was carried out at Monzino, one of the few single-specialist cardiology centers in Europe, dedicated exclusively to the global care of cardiac patients. Interventions such as the Evoque plant require multidisciplinary teams made up of figures with the utmost specialisation, competence and experience: the so-called Hearteams which are consolidated operational realities at Monzino”.
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February 20, 2024 (modified February 20, 2024 | 4:37 pm)
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