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One of the most common complications of tricuspid valve replacement is atrioventricular block (AVB), often requiring permanent pacing. The endocardial pacemaker lead, placed in the right ventricle, may sometimes interfere with the implanted prosthesis, causing its early dysfunction and the need for alternative sites of pacing. To the best of our knowledge, we present the first case of a successful combined percutaneous procedure consisting of the implantation of two leads in the coronary sinus for univentricular bifocal pacing and a transcatheter tricuspid valve-in-valve implantation in a young patient with severe dysfunction of the tricuspid bioprosthesis, requiring permanent pacing for a postsurgical complete atrioventricular block. Tricuspid valve replacement with surgery can often lead to cardiac rhythm disorders requiring a permanent pacemaker. This device may occasionally damage the tricuspid prosthesis. We present the first case of a combined procedure of tricuspid valve replacement and device implantation distant from the prosthesis without the need for a surgical approach in a young patient with severe tricuspid prosthesis malfunctioning and permanent pacing. Article highlights Right-sided infective endocarditis in young patients may be caused by intravenous drug use, leading to tricuspid valve injury and the need for valve replacement with a prosthesis. Complete atrioventricular block represents an important postoperative complication of valve surgery requiring, frequently, the implantation of a permanent pacemaker. The endocardial pacemaker lead in the right ventricle may sometimes interfere with the implanted bioprosthesis, causing its early degeneration with the need for prosthesis replacement and research of other sites of pacing. Surgical replacement of a malfunctioning tricuspid prosthesis is among the highest-risk procedures. A combined percutaneous implantation of two pacing leads in the coronary sinus for univentricular bifocal pacing and a transcatheter tricuspid valve-in-valve may be a safe and effective alternative to surgery in patients requiring a permanent pacing site. In the case of pacemaker dependency, the use of actively fixating leads should be preferable to passive ones in order to minimize the risk of lead dislocation. Other strategies such as pacing with epicardial leads, the use of his-bundle pacing, or leadless pacemakers were taken into account but not deemed suitable. The Heart Team plays a critical role in decision-making in these particular conditions. [ABSTRACT FROM AUTHOR]

Abstract We shall discuss a patient who underwent a tricuspid valve‐in‐valve implantation for a failing bioprosthetic valve replacement. The procedure was complicated by detachment of the valve deployment apparatus which was removed in its entirety, using percutaneous extraction techniques. We believe this was the first ever case to report such a complication.

Despite progressively uncommon in Western countries, rheumatic heart disease still portrays a significant global burden. In elderly or high-surgical risk patients, plurivalvular disease may require a complex percutaneous approach. Transcatheter aortic valve implantation (TAVI) in patients with previous monoleaflet mitral prosthesis is challenging due to interference between the aortic valve and the rigid mitral mechanical prosthesis "ring." Prior cases report the use of CoreValve or Edwards Sapien aortic valves in patients with adequate mitro-aortic distance. Performing a second major procedure, such as tricuspid valve-in-valve (TVIV), sequentially during a single percutaneous intervention, increases treatment complexity. An 83-year-old woman with rheumatic heart disease, with previous implantation of a Bjork-Shiley monoleaflet mitral prosthesis, and Carpentier-Edwards 29 tricuspid bioprosthesis presented with decompensated heart failure due to severe aortic stenosis and tricuspid bioprosthesis stenosis. After HeartTeam discussion, the patient was deemed as inoperable due to a prohibitive surgical risk. As an alternative, a TAVI (Navitor FlexNav) and a transcatheter TVIV replacement (Edwards Sapiens 3 Ultra) were discussed and proposed, with both techniques being performed sequentially in a single procedure. TAVI in a patient with a previous monoleaflet mitral mechanical prosthesis and TVIV may be a feasible approach in inoperable patients with plurivalvular disease., (© 2024 Wiley Periodicals LLC.)

Featured Application: Novel application of valve-in-valve therapy of degenerated bioprosthetic cardiac valves. Reoperation on the tricuspid valve after prior heart valve surgery is associated with an increased operative risk due to a poor clinical status with severe heart failure and late presentation. Transcatheter tricuspid valve-in-valve implantation emerged as an attractive alternative to a high-risk redo surgery. The authors report a case of successful treatment of a failed bioprosthetic tricuspid valve in a 58-year-old woman with severe heart failure, decompensated cardiac cirrhosis and atrial fibrillation using transcatheter tricuspid valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences, Irvine, California) via a transatrial approach. This case demonstrates the efficiency of this novel approach for the treatment of dysfunctional surgical tricuspid bioprosthetic valves and the technical feasibility and safety of a rarely used route. [ABSTRACT FROM AUTHOR]

We shall discuss a patient who underwent a tricuspid valve‐in‐valve implantation for a failing bioprosthetic valve replacement. The procedure was complicated by detachment of the valve deployment apparatus which was removed in its entirety, using percutaneous extraction techniques. We believe this was the first ever case to report such a complication. [ABSTRACT FROM AUTHOR]

Reoperation on the tricuspid valve after prior heart valve surgery is associated with an increased operative risk due to a poor clinical status with severe heart failure and late presentation. Transcatheter tricuspid valve-in-valve implantation emerged as an attractive alternative to a high-risk redo surgery. The authors report a case of successful treatment of a failed bioprosthetic tricuspid valve in a 58-year-old woman with severe heart failure, decompensated cardiac cirrhosis and atrial fibrillation using transcatheter tricuspid valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences, Irvine, California) via a transatrial approach. This case demonstrates the efficiency of this novel approach for the treatment of dysfunctional surgical tricuspid bioprosthetic valves and the technical feasibility and safety of a rarely used route.

Transcatheter tricuspid valve in valve (TViV) is increasingly performed on patients with degenerated bioprosthetic valves and elevated surgical risk. Jailing a right ventricular (RV) pacer lead at the time of TViV implantation has been achieved without causing lead dysfunction; however, device-related complications that require lead extraction raise the need for better periprocedural strategies for TViV, in pacer-dependent patients. We describe a case of device pocket infection with incomplete lead extraction, due to a jailed RV lead at the time of TViV., (© 2019 Wiley Periodicals, Inc.)