First US Extracardiac Tricuspid Valve Replacement Successful

Henry Ford Hospital (HFH; Detroit, MI, USA) is the first hospital in the United States to perform transcatheter tricuspid valve replacement outside of the human heart.

The unique transcatheter tricuspid valve replacement procedure (pioneered in Germany) was performed on a woman who was not a candidate for traditional open heart surgery, due to prior medical procedures. In preparation for the surgery, researchers at the Henry Ford Innovation Institute used three dimensional (3D) modeling to create a working replica of the patient’s heart, which helped the surgical team properly plan the procedure, and predetermine an appropriately sized valve.

The woman’s tricuspid valve was replaced during a two-hour procedure on July 31, 2014. During the procedure, a catheter was threaded percutaneously through a vein in the patient’s groin to her upper abdomen. The first stage involved bracing the inferior vena cava (IVC) with an expandable metal stent. The catheter was then used to insert and expand a transcatheter aortic valve replacement (TAVR) at the junction of the right atrium and the IVC. Once deployed, the new valve stopped blood from leaking and pooling in the patient’s abdomen and lower extremities. The patient was released to her home five days postsurgery.

“There are a lot of people who have damage of the tricuspid valve, and the surgery is risky, so doctors just try to give them medical therapy,” said lead physician for the procedure William O’Neill, MD, medical director of the Henry Ford Center for Structural Heart Disease. “They get a lot of swelling and severe liver congestion. They’re in and out of the hospital, and it really causes a lot of morbidity, so there’s a huge, unmet clinical need. Individuals with this type of valve problem now have another option.”

Dr. O'Neill is an internationally recognized pioneer in interventional cardiology who also developed emergency angioplasty, now a common treatment for heart attacks. He also performed the first transvascular aortic valve replacement in the United States in 2005. He was assisted by Adam Greenbaum, MD, director of the Cardiac Catheterization Lab at HFH, and visiting cardiologist Brian O’Neill, MD, an assistant professor of medicine at the Temple Heart and Vascular Center (Philadelphia, PA, USA).

HFH, the flagship facility for the Henry Ford Health System, is an 802-bed tertiary care hospital, education and research complex in Detroit (MI, USA) which opened in 1915. It is one of the first hospitals in the United States to use a standard fee schedule and favor private or semi-private rooms over large wards. As founder Henry Ford viewed tobacco as being unhealthy, the hospital was one of the first hospitals in to institute a total ban on smoking. HFH annually trains more than 500 residents and 125 fellows in 46 accredited programs. More than 400 medical students train at the hospital each academic year.

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