TCT-168 Predictors of Procedural Abortion and Failure From Right Femoral Access in Transcatheter Tricuspid Valve Replacement With Edwards Evoque System in a Real-World Population

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Abstract

Background: The Evoque system (Edwards Lifesciences) is the only commercially available transcatheter tricuspid valve replacement (TTVR) in the United States for severe tricuspid regurgitation (TR). We examine the determinants of transfemoral Evoque TTVR in a real-world population. Methods: Thirty-four consecutive patients underwent commercial transcatheter tricuspid valve replacement (TTVR) at a tertiary center in the United States in February through June, 2024. We perform retrospective analysis for the factors associated with unsuccessful right transfemoral attempts, including those requiring switching over to left femoral approach and those with abortion. Results: Overall success rate was 79.4% (27/34), including 22 patients from right femoral vein (RFV) access, 4 patients with success after switching from right to left femoral vein (LFV) access, and 1 patient with upfront left femoral access, all of which were switched due to a too ventricular delivery system position from right femoral access with concerns of inability to capture the tricuspid annulus. Abortion rate was 20.6% (7/34), including 4 cases due to overly ventricular system, 1 due to discrepant annular size too large for a 52-m valve on procedure day, and 1 due to venous tortuosity. Right atrial height: the distance from tricuspid annulus to top of right atrium, was larger in patients with initial RFV success group: 72.8 mm (67.4-79.7) compared LFV/aborted group: 65.7 mm (57.9-72.6), rank-sum P = 0.04. Median RA height 72.8 in RFV group, 68.5 in LFV group, and 65.5 in aborted group. TR was more likely to be primary (14%) and functional (77%) in RFV group; and more likely to be pacing-lead induced (33%) or mixed (17%) in LFV/abortion group, chi-square P = 0.033. Atrial fibrillation was less common in LFV/abortion group. No other significant difference was found. Conclusion: Abortion in commercial Evoque TTVR is considerable. Low RA height and TR due to mixed etiology or pacing-leads factors are associated major determinants. Of note, the median values of RA height for switching to LFV access and case abortion are numerically higher than suggested by industry. Preprocedural diuresis to avoid larger-than-expected annular size and awareness of venous tortuosity are also important. Categories: STRUCTURAL: Valvular Disease: Tricuspid.

Volume

84

Issue

18

First Page

B418

Last Page

B419

Find It @ Sladen

Share

COinS