TCT-224 Transcatheter Tricuspid Valve Replacement with Evoque after Tricuspid Transcatheter Edge-to-Edge Repair

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: For patients with severe tricuspid regurgitation (TR) who are not candidates for surgery, tricuspid transcatheter edge-to-edge repair (TTEER) improves QOL. However, not all patients have optimal results of TTEER. Transcatheter tricuspid valve replacement (TTVR) has been reported after TTEER, but short term procedural results are not known, and some TEER devices may interfere with TTVR expansion and require electrosurgical treatment. Methods: We report a case series of TTVR after TTEER, including a large subset who underwent electrosurgical leaflet modification using the CLEFT (Clip LibEration to Facilitate TTVR) technique. Results: Sixteen (16) patients with severe TR after TTEER were treated in 4 centers with TTVR using the Evoque valve (Edwards). Age was 75.3 years, and 68.8% were female. STS PROM was 9.3%. Class III/IV NYHA class was 81.3%, and all patients had severe, massive or torrential TR (Figure 1). Mean number of TEER devices was 1.8. Eight patients underwent successful leaflet laceration with CLEFT prior to TTVR. The Evoque frame conformed to the TEER devices visibly (Figure 1). TR severity was excellent at 30 days (Figure 1) and only 13.3% had TR greater than mild. NYHA class I/II at 30 days was 86.7%. [Formula presented] Conclusion: We present the largest series to date (16 cases) of successful TTVR after TTEER. Electrosurgical leaflet modification was performed in a large subset of patients, successfully optimizing leaflet function and TEER mobility prior to TTVR. At 30 days, tricuspid regurgitation severity at 30 days was excellent, with no cases of severe paravalvular leak, and NYHA Class was improved. Categories: STRUCTURAL: Valvular Disease and Intervention: Tricuspid

Volume

86

Issue

17

First Page

B99

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