Cardiologists at UC Davis Medical Center recently completed their first transcatheter tricuspid valve replacement (TTVR) procedure, becoming the first hospital in the Sacramento region to perform the minimally invasive treatment.
The TTVR procedure was performed as part of a clinical trial. It treats tricuspid regurgitation, a condition where the tricuspid valve of the heart fails to close completely. This problem can allow blood to leak backward into the atrium from the leaky tricuspid valve, causing the patient's heart to pump harder to move blood through the valve.
Tricuspid regurgitation currently affects an estimated 1.6 million Americans. Symptoms include active pulsing in the neck veins, enlarged liver, fatigue and swelling throughout the body.
Current nonsurgical treatments for tricuspid regurgitation include diuretics (medicines that help remove excess fluid and salt) and drugs aimed at treatment of the symptoms only. Left untreated, tricuspid regurgitation can lead to atrial fibrillation, heart failure, kidney disease and even death.
"Patients diagnosed with tricuspid regurgitation unfortunately have a relatively high mortality when treated with medications alone," said Gagan D. Singh, associate professor of cardiovascular medicine, who performed the TTVR procedure. "Open heart surgery for these patients is high risk and has typically been associated with poor outcomes and has typically been avoided. This procedure offers a new option for patients in the Sacramento area to have a better and longer life."
A minimally invasive valve replacement
For the procedure, Singh and members of the Structural Heart Team inserted a catheter topped with the replacement valve through a small incision in the patient's groin. They threaded the device through a vein up to the heart and positioned it inside the faulty tricuspid valve. The artificial valve then opened like an umbrella and anchored in place. It started working immediately.
The patient was up and walking within four to six hours and then discharged from the hospital 48 hours after the procedure. The patient's symptoms quickly improved, resulting in a significant improvement in their overall quality of life.
"Dr. Singh and our entire cardiovascular medicine team have been instrumental in bringing impactful structural heart trials to UC Davis to develop life changing solutions for some of our most complex patients," said Thomas Smith, chief of cardiovascular medicine. "Efforts like this are an example of the power of our multidisciplinary teams, where we are aiming to deliver optimal outcomes for our patients."
11 patients have signed up for the TTVR clinical trial so far. Singh and his colleagues will monitor participants for five years after their procedure.
Positive results could lead to clearance by the Food and Drug Administration for commercial availability of the procedure in the United States.
