Transvenous valve‐in‐valve replacement preserving the function of a transvalvular defibrillator lead

Abstract

Although feasibility and efficacy of percutaneous tricuspid valve-in-valve implantation have been established, a transtricuspid pacing or defibrillator lead might preclude this technique: lead damage can cause lead dysfunction resulting in inappropriate or inefficient pacing or shocks. In these cases, lead removal is thought to be the only option. We describe a patient who presented with rapid clinical deterioration due to tricuspid valve stenosis early after implantation of an internal defibrillator with a transvalvular shock-lead. A transvenous valve-in-valve implantation of the tricuspid valve was performed after protecting the defibrillator-lead with a custom-made covered stent. We describe the technical issues, the clinical outcome, and the evolution of lead function after implantation.

Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads

“…In cases of bioprosthetic TV dysfunction with the presence of a PM or ICD lead (both related and unrelated to the valvular dysfunction), there have been reports of successful percutaneous valve‐in‐valve replacements in which the original leads are jailed between the two prosthetic annuli, without lead dislodgements or significant alterations in function . However, as with the surgical approaches in which leads are jailed in place, it should be noted that any future complications with the lead requiring removal would necessitate open surgery.…”