Ct-Only Expedited Evaluation for Transcatheter Tricuspid Valve Replacement: An Initial Experience

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Cardiovasc Comput Tomogr

Keywords

artifact, clinical article, clinical outcome, computed tomographic angiography, computer assisted tomography, conference abstract, contrast enhancement, controlled study, diagnosis, female, human, image quality, Kansas City Cardiomyopathy Questionnaire, length of stay, male, paravalvular leak, patient selection, pilot study, transesophageal echocardiography, tricuspid valve, tricuspid valve prosthesis, tricuspid valve regurgitation, tricuspid valve replacement

Abstract

Introduction: Transcatheter tricuspid valve replacement (TTVR) with the EVOQUE system has emerged as a therapeutic option for patients with severe tricuspid regurgitation. Current pre-procedural evaluation relies on incorporating Transesophageal Echocardiography (TEE) and Cardiac Computed Tomography Angiography (CCTA). However, the tricuspid valve TEE increases workflow complexity, can be technically challenging and carries procedural risks. We hypothesized that in patients with high-quality CCTA, CT alone may provide sufficient information to determine candidacy for TTVR. Methods: 141 patients were evaluated for TTVR. 110 consecutive patients underwent a standard pathway consisting of both CCTA and TEE. 31 patients were evaluated using a CT-only pathway. CT studies were assessed for suitability based on three predefined domains: (1) contrast enhancement measured by mean Hounsfield Unit (HU) values; (2) anatomical visualization of the tricuspid valve and right-sided structures; and (3) artifact burden. Patients with inadequate CT image quality were redirected to the TEE + CT pathway. Results: Out of 31 patients submitted (age 77.8 ± 8.8 years; 9 male, 29%), 19 (61.3%) met criteria for CT-only expedited evaluation and 8 (25.8%) underwent TTVR during the pilot period. 12 (38.7%) patients were excluded from the CT-only pathway due to image quality, although of these, 6 (19.4%) were re-evaluated and had TTVR utilizing traditional TEE + CT. When comparing the 8 CT-only TTVR patients to the 110 (age 77.3 ± 9.7 years; 35 male, 32%) baseline TTVR patients, no significant differences were observed for in-hospital mortality (n=0 8 [0%] vs n=1 110 [0.01%], p=0.32), Kansas City Cardiomyopathy Questionnaire improvement (18.8±20.7 vs 26.5±18.0, P=0.26), or >mild paravalvular leak (n=1 8 [12.5%] vs n=7 110 [6.4%], p=0.14). When comparing the 8 CT-only TTVR patients with 6 redirected TEE+CT pathway TTVR patients, there was no statistical difference in hospital length of stay (3.1±2.5 days vs 2.5±2.0 days, p=0.07), procedural time (146.8±7.1 min vs 110.2±12.9 min, p=0.1), and all patients survived to discharge. Conclusions: In this pilot experience, high-quality CCTA allowed a subset of patients to undergo expedited evaluation for TTVR without routine pre-procedural TEE. These findings suggest that a CT-first screening strategy may be feasible and could streamline pre-procedural assessment. Further experience is needed to define patient selection criteria and evaluate the potential impact on workflow efficiency, cost, and clinical outcomes.

Volume

20

Issue

4

First Page

S112

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