Ct-Derived Predictors of Access Strategy in Transcatheter Tricuspid Valve Replacement and Their Association with Procedural Efficiency

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Cardiovasc Comput Tomogr

Keywords

acetarsol, algorithm, benchmarking, computed tomographic angiography, computer assisted tomography, conference abstract, device comparison, diagnosis, female, fluoroscopy, heart right atrium, human, inferior cava vein, major clinical study, male, prospective study, radiation exposure, retrospective study, superior cava vein, surgery, tricuspid annulus, tricuspid valve prosthesis, tricuspid valve replacement

Abstract

Introduction: The EVOQUE Tricuspid Valve Replacement System (Edwards Lifesciences, Irvine, California) is a recently approved platform for transcatheter tricuspid valve replacement (TTVR), typically delivered via transfemoral venous access. Device deployment is progressive and largely irreversible, making accurate initial positioning critical. Because the delivery system has limited maneuverability, access route selection may influence device alignment and procedural efficiency. Preprocedural cardiac computed tomography angiography (CCTA) provides characterization of right heart geometry that may influence access strategy. We sought to evaluate CT-derived anatomic predictors of access selection and their relationship to procedural efficiency during EVOQUE TTVR. Methods: 83 patients (age 77.4±9.8 years) who underwent TTVR with the EVOQUE system were retrospectively analyzed. Venous access was selected following multidisciplinary heart team discussion and included right transfemoral (RTF, n=60), left transfemoral (LTF, n=14), right internal jugular (RTJ, n=3), and left internal jugular (LTJ, n=6) approaches. Preprocedural CCTA measurements included right atrial height, superior vena cava (SVC) offset angle and length, inferior vena cava (IVC) offset angle and length, and tricuspid annular orientation. Procedural metrics included total procedure time, fluoroscopy time, and radiation exposure (air kerma). Results: Right atrial height differed significantly by access strategy. Patients undergoing left sided access demonstrated shorter right atrial height compared with those undergoing right-sided access (LTF 57.5±5.2 mm; LTJ 59.8±4.7 mm vs RTF 72.3±11.0 mm; RTJ 68.2±3.0 mm; p<0.001). SVC and IVC offset angle and length parameters did not significantly differ between groups (p>0.31). Similar to RA height, right sided access was successful in larger tricuspid annulus angles while left sided access success is seen with smaller angles (92.6±16.7° vs 105.0±7.5°, p=0.03). The left transjugular approach demonstrated shorter fluoroscopy time (33.7±6.3 min) compared with transfemoral and right transjugular approaches, with lower associated radiation exposure (air kerma 263.7±74.1 mGy). Procedure duration was also shortest with LTJ access (117.5±18.4 min). Conclusions: CT-derived right heart anatomy is associated with access strategy during EVOQUE TTVR. Shorter right atrial height was more frequently observed in patients undergoing left-sided access approaches. Access route was associated with differences in fluoroscopy time, radiation exposure, and overall procedure duration. These findings suggest that systematic preprocedural CT assessment of heart geometry may help guide access selection and improve procedural efficiency in TTVR. Prospective studies are needed to validate CT-based algorithms for access planning.

Volume

20

Issue

4

First Page

S113

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