IJN marks regional first in heart valve procedure

Institut Jantung Negara (IJN) has successfully performed the first transcatheter bioprosthesis implantation in the Asian region for patients with severe triscuspid regurgitation (TR).

TR refers to the backflow of blood into the right atrium due to inadequate closure of the tricuspid valve. In cases of severe TR, this backflow may extend to the vena cava (caval reflux), potentially leading to right-sided heart failure if left untreated. Symptoms include fatigue, abnormal heart rhythms, shortness of breath, and swelling in the legs and abdomen, although symptoms may not develop in the early stages of disease.

Underlying causes of TR include congenital defects, or enlargement of the right ventricle from several possible conditions (eg, heart failure, pulmonary hypertension, or cardiomyopathy).

While mild TR can be managed with pharmacotherapies such as diuretics, severe cases call for valve repair or replacement procedures.

However, some patients with severe TR are unable to withstand the risks of surgery, while others may have other conditions that make them unsuitable for certain surgical procedures, said Dato’ Dr Azmee Mohd Ghazi, clinical director at IJN’s Heart Failure and Heart Transplant Centre.

“For instance, a common surgical option for TR is annuloplasty, a procedure that tightens the ring around the valve in the heart. Unfortunately, patients with severely dilated tricuspid annulus or with prior pacemaker or other underlying conditions are not suitable for such a procedure,” said Azmee.

“For such cases, it is important that we are able to offer a new innovative treatment like TricValve^® to help more patients alleviate their symptoms and improve their quality of life,” he added.

This minimally invasive procedure employed the TricValve^® dual-valve bioprosthesis; a dry stent valve on a preloaded delivery system, implanted at the superior and inferior venae cavae, allowing treatment of caval reflux in severe TR without removing the existing defective tricuspid valve.

The procedure was carried out in May 2021 by experts at IJN’S cardiology department and Heart Failure and Heart Transplant Centre.

IJN’s chief executive officer and senior consultant cardiologist Datuk Dr Aizai Azan Abdul Rahim expressed his appreciation for the efforts of the team involved in the groundbreaking procedure.

“It’s no secret that IJN’s success has been built on the willingness of our staff to keep learning, exploring for new innovative treatments that can enhance our patients’ quality of life, and pushing the boundaries to be able to treat more patients who are deemed unsuitable for surgeries,” said Aizai.

Developed by P+F, the TricValve^® system received a Breakthrough Device Designation by the US FDA in December 2020 and is indicated for patients with severe TR.