Transcatheter Tricuspid Valve Replacement In Patients With Pacemakers: Can Cardiac Computed Tomography Analysis Predict Failure?
Recommended Citation
Fram G, Gupta K, Nguyen F, Rangavajla G, Mohammed M, Obeidat L, Saleem M, Alrayes H, Kar Lok Lai L, Dawdy J, Parikh S, Zweig B, Alter J, Lai K, Engel Gonzalez P, Villablanca P, Frisoli T, O’Neill BP, Ilg KJ, Lee J. Transcatheter Tricuspid Valve Replacement In Patients With Pacemakers: Can Cardiac Computed Tomography Analysis Predict Failure?. J Cardiovasc Comput Tomogr 2025; 19(4):S98-S99.
Document Type
Conference Proceeding
Publication Date
7-1-2025
Publication Title
J Cardiovasc Comput Tomogr
Abstract
Introduction: Transcatheter tricuspid valve replacement (TTVR) with the Evoque valve (Edwards Lifesciences, USA) is a novel therapy in management of patients with severe tricuspid regurgitation (TR) at high risk for surgical intervention. The Evoque valve is stabilized by anchors as well as radial force from oversizing the to the tricuspid annular area. The potential impact of this radial force on permanent pacemaker (PPM) function in patients undergoing TTVR is inadequately understood. Methods: We retrospectively analyzed twenty patients who underwent commercial TTVR at a single center who had PPM prior to TTVR. Pre-procedural cardiac computed tomography (CCT) studies were analyzed to evaluate percent annular oversizing of the implanted valve. Measurements were performed using a variety of techniques including vendor supplied measurements, CCT multiplanar reconstruction measurements with no annular height offset (MPR), and CCT annular measurements using a minimum intensity projection (minIP). Lead slack was measured as a tortuosity index using curved reformatting of PPM lead length of the superior vena cava-atrial junction to lead insertion point divided by the straight-line distance. Post-procedurally, all patients had PPM interrogation to assess for signs of pacemaker dysfunction, defined as elevated lead thresholds as adjudicated by cardiac electrophysiology. Results: Two patients had signs of PPM dysfunction post-TTVR (11.1%). There was no difference between percent oversizing of the valve in patients who had PPM dysfunction post-procedurally utilizing vendor (18.0% vs 18.5%, p=0.90), MPR (12.4% vs 12.9%, p=0.80), and minIP measurements (18.4% vs 19.9%, p=0.61) techniques respectively. There was no difference amongst the degree of lead slack among patients with normal PPM function compared to PPM dysfunction (tortuosity index: 1.35 vs 1.30, p=0.70). Conclusions: CCT-derived tricuspid annular oversizing and PPM slack as defined as tortuosity index does not appear to predict post-procedural PPM dysfunction in our cohort of patients with severe TR and pre-existing PPM. However, this study has several limitations, namely this being a small retrospective sample size with a low event-rate. Further research is needed to identify patient specific CCT predictors of PPM lead dysfunction post TTVR.
Volume
19
Issue
4
First Page
S98
Last Page
S99
