https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie und internistische Intensivmedizin Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland; 3Universitätsklinikum Schleswig-Holstein Klinik für angeborene Herzfehler und Kinderkardiologie Kiel, Deutschland
Background:
Several transcatheter tricuspid valve replacement (TTVR) systems are being trialled in clinical studies to close the gap in care for tricuspid regurgitation (TR) that cannot be treated by transcatheter edge-to-edge repair. These procedures have also been started to be performed at the UKSH, Campus Kiel. Here we report patient characteristics and procedural outcomes of this new patient cohort.
Methods:
This is a single-centre registry study with prospective inclusion of all consecutive patients treated with TTVR, using three different devices (Cardiovalve, Venus MedTech, China; VDyne, VDyne, USA; EVOQUE, Edwards Lifesciences, USA) at the UKSH Kiel campus. Endpoints were defined by the TVARC criteria.
Results:
From January 2023 to November 2024, 17 patients have undergone TTVR. The median age was 80 years (IQR 78 - 85), 15 were female (88%). A median TriScore of 5 (IQR 4-5) indicated a high burden of comorbidities. 12 (71%) had a baseline TR-Grade of 5 “torrential”. Technical success was achieved in 14/17 patients (82%) as in two patients the procedure was aborted and in one technical failure led to conversion to heart surgery. Two patients died during the hospital stay due to severe bleeding in a patient with a mechanical heart valve and septic shock in the patient who had to undergo surgery. The median device time was 41 minutes (31 - 65), patients with technical success had a median of 10 days length of hospital stay. 7 patients had a pre-existing pacemaker/ICD. No patient developed conductions disturbances. In all patients with technical success, TR grade at discharge was equal or less than mild. The 30-day survival rate in patients with technical success was 100%.
Conclusion:
Given the partially experimental device experience, this report from a university medical centre proves TTVR to be a feasible and safe therapeutic option in heart failure patients with severe TR, who were not eligible for T-TEER. Technical success rate was lower than in T-TEER cohorts. All three technical failures were associated with delivery system draw backs. Further refinements in TTVR systems and patient selection most probably will improve technical and device success.