Bonilla-Aguila, Oswaldo; García-Cruz, Edgar; Sánchez-Nieto, Jorge; Luna-Hernández, Andrea Magdalena; Angulo-Cruzado, Stephanie Teresa

ABSTRACT

Introduction: dysfunction of tricuspid bioprostheses is a major challenge in patients with congenital heart disease who have undergone multiple interventions. Although transcatheter valve-in-valve implantation restores prosthetic valve function, subsequent right atrial reverse remodelling remains poorly characterised, particularly in cavopulmonary physiology. Objective: to assess right atrial remodelling and the haemodynamic and clinical response after transcatheter tricuspid valve-in-valve implantation. Material and methods: single-centre, retrospective observational study of 19 patients with dysfunction of a surgically implanted tricuspid bioprosthesis. Clinical, echocardiographic, and procedural variables were collected. Fourteen patients had paired echocardiographic studies before and after the procedure. Paired Student’s t test, Wilcoxon signed-rank test, or McNemar test were used, as appropriate. Results: median age was 33 years; 73.7% were women, 84.2% had Ebstein anomaly, and 31.6% had a cavopulmonary connection. Indexed right atrial volume decreased in all 14 patients, from 127.84 ± 63.11 to 68.07 ± 22.90 mL/m², with a mean reduction of 59.77 mL/ m² (95%CI: 32.72-86.82; p ‹ 0.001; Hedges’ g = 1.24). Mean transprosthetic gradient decreased from 12.38 ± 4.49 to 5.26 ± 1.74 mmHg (p ‹ 0.001), moderate or severe intraprosthetic regurgitation from 57.1 to 0% (p = 0.003), and NYHA class improved in 13 of 14 patients (p ‹ 0.001). Technical success was 100%, with no surgical conversion or in-hospital mortality. Conclusions: transcatheter tricuspid valve-in-valve implantation was associated with right atrial reverse remodelling, haemodynamic recovery, and functional improvement, including a favourable response in cavopulmonary physiology

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