Innovations 2004 page 2 of 5
PERCUTANEOUS FUNCTIONAL TRICUSPID VALVE
Cleveland Clinic performed the first percutaneous tricuspid valve replacement, using a device developed at our institution. The patient had severe radiation heart disease, had undergone previous pericardectomy, and was plagued by recurring ascites due to severe tricuspid regurgitation. At one-year follow-up, her new valve remains competent, and her quality of life is improved.
This three-dimensional reconstruction CTA depicts the implanted valve within the inferior vena cava (white arrow) immediately inferior to the right atrium. Note the absence of contrast inferior to the valve (orange arrow). This demonstrates competence of the valve.
SELF-SUPPORTED ANNULOPLASTY
This complete, self-supported, and semi-flexible mitral and tricuspid annuloplasty stent-ring is introduced percutaneously and deployed into the supra-annular valvular position using balloon expandable technology.
Purposes of this prosthetic ring are to restrict and support the native annulus, correct and prevent valvular regurgitation, and reestablish the normal shape and contour of the native annulus, allowing effective functioning of the valve. This system is being developed by staff surgeon José L. Navia, M.D.
PERCUTANEOUS PLACEMEMENT OF VAD
Cleveland Clinic has begun to use the TandemHeart® PTVA® System, a new centrifugal left ventricular assist device (VAD) manufactured by CardiacAssist, Inc. The TandemHeart® is inserted percutaneously and allows rapid implementation of circulatory support in the cardiac catheterization laboratory or operating room.
The TandemHeart® is being investigated as a treatment for select patients recovering after revascularization of acutely occluded coronary arteries. It can be used to temporarily support patients in cardiogenic shock as a bridge to other circulatory support devices or to recovery. It may also be used to support patients after surgery when weaning from cardiopulmonary bypass has failed.
A catheter is threaded from the femoral vein in the patient’s groin into the left atrium (via an interatrial puncture) and oxygenated blood is withdrawn and returned to the femoral artery. Image used with permission from CardiacAssist, Inc.
ENDOSCOPIC RADIAL ARTERY HARVESTING
In 2005, we expanded our minimally invasive offering to include harvesting of radial arteries. Our experience with endoscopic saphenous vein harvesting provided a solid technical skill base. Patients are pleased with the aesthetics, recovery, and comfort of this less invasive approach.
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