Tricuspid regurgitation (TR) affects a wide population in China, and frequently coexists with other conditions as comorbidities. Moderate to severe TR is associated with a poor prognosis and medical treatment alone does not prevent progression of disease. Although minimal invasive catheter-based techniques might be an option for TR treatment in selected high risk patients, there is no relevant recommendations for the transcatheter treatment of TR in practice guidelines. Several transcatheter edge-to-edge repair devices are currently in preclinical and early clinical evaluation as potential novel treatment options for symptomatic TR in patients at increased risk for surgery, becoming as the most common technique applied for interventional TR treatment. Hence, the present study will introduce the clinical features of TR, the progress of edge-to-edge repair, and the application and challenges in the future.
This paper reported a 75-year-old female patient. She was admitted to our hospital for “repeated chest pain, shortness of breath for more than 5 years, and syncope 3 times”. The CT scan of the patient showed severe aortic valve stenosis, bicuspid valve, and severe calcification; then she underwent transcatheter aortic valve replacement in our hospital. After the prosthesis was implanted, there was a significant paravalvular leak. Considering the triangular area formed between the calcified clumps, the valve was not fully dilated. Paravalvular leak closure was performed during the operation, attempted through the valve stent mesh to closuring. A rare incarceration of the transmitter occurred. An attempt was made to pull out the incarcerated transmitter through a pull-up technique, which resulted in the prosthesis prolapse. The patient was eventually transferred to surgery aortic valve replacement.
Nowadays, aortic bioprostheses are used more and more widely in clinical practice, but the valve will experience structural valve degradation over time, and eventually lose its function, which is valve failure. Valve failure has become a significant challenge for aortic valve replacement and especially limits the expansion of indications for transcatheter aortic valve replacement. This review focuses on the current status and relevant evidence on the definition, risk factors, epidemiological characteristics, diagnosis and evaluation, treatment strategies of aortic bioprostheses failure. The purpose is to provide a basis for a more comprehensive understanding of aortic bioprostheses failure, finding better coping strategies and further improving the long-term durability of the valve.