Pre-Procedure Ccta Assessment of Cied Lead Position in Risk Stratifying Patients for Incidence of Perivalvular Leak after Transcatheter Tricuspid Valve Replacement
Recommended Citation
Hamade H, Alter J, Lai K, Fram GK, Obeidat L, Yap R, Giacaman Saavedra A, Parikh S, Zweig BM, Saleem M, O’Neill B, Villablanca P, Engel Gonzalez P, Frisoli T, Lee JC, Dawdy J. Pre-Procedure Ccta Assessment of Cied Lead Position in Risk Stratifying Patients for Incidence of Perivalvular Leak after Transcatheter Tricuspid Valve Replacement. J Cardiovasc Comput Tomogr 2026; 20(4):S113-S114.
Document Type
Conference Proceeding
Publication Date
7-1-2026
Publication Title
J Cardiovasc Comput Tomogr
Keywords
aged, cardiac implantable electronic device, clinical article, complication, computer assisted tomography, conference abstract, explant, female, human, incidence, male, paravalvular leak, retrospective study, subcutaneous tissue, transesophageal echocardiography, tricuspid valve, tricuspid valve prosthesis, tricuspid valve replacement
Abstract
Introduction: The risk of paravalvular leak (PVL) post transcatheter tricuspid valve replacement (TTVR) is well known but poorly described, particularly in the presence of cardiac implantable electronic devices (CIED). We sought to determine if CIED lead placement assessed by computed tomography (CT) pre-procedure could predict risk of PVL. Methods: This is a retrospective analysis of 32 patients who underwent TTVR in presence of CIED between February 2024 and April 2025 (average age of 79.8±6.1, 59% male). All patients received EVOQUE tricuspid valve replacement system (Edwards Lifesciences, Irvine, California). Gated CT and 3D software was used to create short axis cines of tricuspid valve. Lead placement within valve was graded as: subcutaneous leadless, commissural, leaflet interaction, no leaflet interaction, or multiple leads with differing lead positions. Immediate post-deployment transesophageal echocardiography reported PVL as: none, trivial, mild, mild-moderate, moderate, moderate-severe, or severe. Lead placement was compared to severity of reported PVL. Results: Perivalvular leak was noted in 9 patients (28.1%). The highest incidence was noted among patients with leads in the mid anatomic regurgitant orifice area (AROA) with no leaflet interaction (40%) and patients with a lead having leaflet interaction (27.3%). In all cases, PVL ranged from trivial to mild-moderate. There were 3 cases of mild PVL (18.2% of patients with a lead having leaflet interaction, 20% of patients with lead with no leaflet interaction). There was 1 case of mild-moderate PVL noted in patient with a lead having leaflet interaction (9.1%). Conclusions: Pre-procedural CT assessment of lead placement may help risk stratify patients for developing PVL. CIED leads that are directly interacting with leaflets or positioned in mid AROA without leaflet interactions may be associated with higher incidence and severity of PVL. While further data is required to better understand this association, this raises the question regarding the need for lead explant prior to intervention in patients with leads in such positions. [Formula presented]
Volume
20
Issue
4
First Page
S113
Last Page
S114
