Leakage of the tricuspid valve (tricuspid insufficiency) is often the result of severe heart disease or pulmonary hypertension. Tricuspid insufficiency leads to a pendulum flow in the right heart, shortness of breath and water retention in the abdomen and legs, and even right heart failure. Tricuspid insufficiency is usually treated with medication using diuretics. In recent years, the catheter-guided procedure ("edge-to-edge repair") has also become established as a therapy, in which two heart valve leaflets are connected with an implant. However, the procedure is highly dependent on the patient's anatomy and cannot be used for a large group of patients. For example, large gaps between the heart valve leaflets or severe restrictions to these make edge-to-edge therapy difficult or impossible. In order to achieve broader applicability, research into the development of a catheter-based tricuspid valve replacement has been ongoing for several years. This new technology has now been successfully used for the first time in Austria outside of a clinical trial at University Hospital Vienna and MedUni Vienna.
At the end of 2023, Philipp Bartko and his team at the Clinical Division of Cardiology at University Hospital Vienna and MedUni Vienna performed the first catheter-based tricuspid valve replacement via the groin in Austria. In spring 2024, a new heart valve prosthesis, which is approved for widespread use and differs from previous prostheses in terms of size and implantation technique, was implanted for the first time. In the new heart valve replacement, the tricuspid valve leaflets are gripped by several anchors and connected to the new valve as a functional unit. The procedure is performed under general anesthesia on a beating heart via a blood vessel in the groin. Leakage of the tricuspid valve can be treated in a minimally invasive and highly individualized manner using the new procedure. "This new procedure offers a very effective and innovative treatment option for patients who have previously been treated inadequately with medication or who could not be treated with edge-to-edge therapy," says Philipp Bartko, who performed the procedures together with Caglayan Demirel, Cardiologist and specialist in interventional heart valve therapy at the Department of Medicine II. "There was no alternative for the patient. The new procedures led to a significant improvement in his symptoms and reduced the need for drainage medication."
The procedure was carried out in close interdisciplinary collaboration between experts in cardiology, cardiac surgery, radiology, anesthesia, nursing and technicians in the hybrid operating theatre at the University Hospital Vienna. "The hybrid operating room creates the ideal conditions for these new innovative treatment options," says Christian Hengstenberg, Head of the Clinical Division of Cardiology at University Hospital Vienna and MedUni Vienna. "We are delighted that the new prosthesis optimally complements our portfolio of interventional heart valve therapies. In this way, we can guarantee even more individualized patient care in terms of precision medicine."