First Minimally Invasive Tricuspid Valve Replacement in San Diego County Completed by Scripps Cardiologists

Scripps Clinic cardiologists recently became the first in San Diego County to replace a tricuspid heart valve in a patient using a minimally invasive procedure that threads the device into the heart through a small incision in the groin.

The heart team led by interventional cardiologist Curtiss Stinis, MD, along with Matthew Price, MD, and Steven Romero, MD, performed the 2-hour procedure, known as a transcatheter tricuspid valve replacement or TTVR, July 7 at Scripps Memorial Hospital La Jolla on an 80-year-old man who suffered from worsening symptoms of congestive heart failure and fluid retention. This was due to a faulty tricuspid valve that allowed blood to flow backward within his heart.

Scripps is the only healthcare system in San Diego participating in the ongoing international clinical trial testing the investigational device.

"This procedure, if validated through this study, could offer new hope to these patients for a better and longer life.”

Medications were no longer controlling the patient’s symptoms, and he wasn’t healthy enough to undergo a more conventional and invasive open-heart surgery to replace the valve.

“Patients with isolated severe tricuspid regurgitation unfortunately have a relatively high mortality when treated with medications alone,” Dr. Stinis said. “Open heart surgery for these patients is high risk and has typically been associated with poor outcomes, and thus is typically avoided. This procedure, if validated through this study, could offer new hope to these patients for a better and longer life.”

The study is the latest effort to repair or replace faulty parts of the heart with catheter-based procedures that are far less invasive than surgery and have the potential for much shorter recovery times. Scripps has participated in many of the pivotal clinical trials that validated earlier procedures involving the other three valves of the heart, including transcatheter aortic valve replacement or TAVR. The tricuspid valve is one of the final frontiers in this medical technology revolution largely because of its challenging anatomy.

For the procedure, Dr. Stinis inserted a catheter topped with the EVOQUE replacement valve made by Edwards Lifesciences through a small incision in the patient’s groin and threaded the device through a vein up to the heart, where it was positioned inside the faulty tricuspid valve, opened like an umbrella and anchored in place. The artificial valve, which is made of cow heart tissue, a metal frame and a fabric skirt, started working immediately.

The patient was discharged from the hospital the morning after the procedure, and follow-up testing showed no further evidence of tricuspid regurgitation. Dr. Stinis said he expects the patient’s symptoms to quickly improve over the coming weeks, resulting in a significant improvement in the overall quality of his life.