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Failing surgical tricuspid valve bioprostheses can be salvaged via valve-in-valve implantation of transcatheter aortic and pulmonary valve prostheses, a multinational registry study showed.

There was a 98.7% success rate associated with the off-label procedure. By 30 days, (New York Heart Association class I or II) -- a drastic improvement compared with 71% having marked or severe functional limitation before treatment, , of Stanford University in Palo Alto, Calif., and colleagues found.

Four patients had residual tricuspid valve dysfunction after the intervention, however, and the 30-day mortality rate was 3.3%. Over a median follow-up of 13.3 months, 14.5% died.

"Tricuspid valve-in-valve using commercially available transcatheter prostheses is technically and clinically successful in patients of varying age across a wide range of valve size," the investigators concluded online in Circulation, calling the procedure a "viable option" for treating degenerating tricuspid valve bioprostheses.

"Tricuspid valve-in-valve replacement is an appealing option for many patients, insofar as it may avoid higher-risk redo sternotomy and tricuspid valve replacement in patients who are often clinically compromised," the authors noted.

The study "extends our previous experience with aortic, mitral, and pulmonic valve-in-valve procedures to the tricuspid position," , of Columbia University Medical Center in New York City, and colleagues, wrote in an accompanying editorial.

"While the latter procedure remains off-label, we feel optimistic that this will change," they said, although noting that McElhinney's study included only 152 tricuspid valve-in-valve implantation cases from 2008 through 2015 and with a median of two patients enrolled per center, "limiting any potential learning curve."

Moses and colleagues argued that the approach is appealing for two reasons: first, "large bore access is simplified given the venous approach for these cases" and second, "because the bioprosthesis is frequently large, some of the pitfalls in smaller valves seen in aortic and mitral valve-in-valve could be avoided," they wrote.