A Dynamic Right Atrium In Transcatheter Tricuspid Valve Replacement: Friend Or Foe?
Recommended Citation
Fram G, Obeidat L, Saleem M, Alrayes H, Kar Lok Lai L, Mohammed M, Parikh S, Zweig B, Dawdy J, Alter J, Lai K, Song T, Pantelic M, Bowerman N, Engel Gonzalez P, Villablanca P, Frisoli T, O’Neill BP, Lee J. A Dynamic Right Atrium In Transcatheter Tricuspid Valve Replacement: Friend Or Foe?. J Cardiovasc Comput Tomogr 2025; 19(4):S53.
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 therapeutic approach for treating patients with severe tricuspid regurgitation who are at high surgical risk. Due to the limited mobility of the delivery system, the successful treatment of patients may depend on patient-specific anatomical features. In this study, we evaluated characteristics from pre-procedural cardiac computed tomography (CCT) that may have impacted the success of the procedure. Methods: A retrospective analysis was conducted on fifty patients who had undergone attempted TTVR at a large, high-volume center. All patients had pre-procedural CCT, which was analyzed for volumetric right ventricle (RV) and right atrium (RA) size in systole and diastole, linear metrics of RV function, and annular height. A successful procedure was defined as the deployment of the TTVR without procedural mortality. Results: Among the cohort of the first fifty patients to undergo commercial TTVR, no implant was placed in 10 patients. Among those without procedural success, valve deployment failed in 9 patients, and mortality occurred in 1 patient. A regression model statistical analysis showed no association between lack of procedural success and CT fractional area change (p=0.79), CT RV free wall shortening (p=0.40), CT longitudinal fractional shortening (p=0.84), RA height (p=0.35), or TV annular height (p=0.50). However, a reduced CT-based RA emptying fraction (RA diastole - RA systole / RA diastole) was more likely to be associated with procedural success (p=0.02). Conclusions: Patients with highly dynamic right atrial function undergoing TTVR with the Evoque valve may have a higher rate of procedural failure. This could be related to the variable sizing of the RA and the fixed length of the Evoque delivery catheter. Additionally, the device cannot be retrieved after the unsheathing process begins, and unstable delivery system positioning may hinder depth measurements, leading to decisions to abort the procedure prior to device deployment. Pre-procedural CCT is a cornerstone for planning this highly complex procedure. Further, larger studies are needed to confirm these findings. [Formula presented]
Volume
19
Issue
4
First Page
S53
