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. 2024 Dec 9;17(23):2732-2744.
doi: 10.1016/j.jcin.2024.09.019.

Eligibility for Transcatheter Tricuspid Valve Interventions in Patients With Tricuspid Regurgitation

Tetsu Tanaka  1 , Johanna Vogelhuber  2 , Can Öztürk  2 , Miriam Silaschi  3 , Farhad Bakhtiary  3 , Sebastian Zimmer  2 , Georg Nickenig  2 , Marcel Weber  2 , Atsushi Sugiura  2
Affiliations

Eligibility for Transcatheter Tricuspid Valve Interventions in Patients With Tricuspid Regurgitation

Tetsu Tanaka et al. JACC Cardiovasc Interv. .

Abstract

Background: It remains unclear what proportion of patients with tricuspid regurgitation (TR) are suitable candidates for transcatheter tricuspid valve intervention (TTVI) in clinical practice.

Objectives: The aim of this study was to ascertain the prevalence of eligibility for tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) devices among patients with TR.

Methods: The tricuspid valve anatomy of all consecutive patients with TR who were considered for TTVI in local heart team conferences was retrospectively reviewed. According to current expert consensus, the anatomical feasibility for T-TEER was classified into 3 groups: favorable, feasible, and unfavorable anatomy. Clinical and anatomical eligibility for TTVR was evaluated in patients with cardiac computed tomographic (CCT) images.

Results: Among 491 patients, 99 (20.2%) and 235 (47.9%) were considered to have favorable and feasible anatomy for T-TEER, respectively. In contrast, 157 patients (32.0%) had unfavorable anatomy for T-TEER. The most common reason for unfavorable anatomy for T-TEER was large coaptation gap width (66.2%), followed by anteroposterior TR jet location (62.4%). Among 327 patients with CCT images, 205 (62.7%) were judged to be clinically or anatomically ineligible for TTVR, mainly because of tricuspid annuli larger than commercially available prosthesis sizes (65.4%). Combined echocardiographic and CCT assessment showed that 23.2% of the patients with TR were ineligible for both T-TEER and TTVR.

Conclusions: Of 491 patients requiring TTVI, 32.0% had unfavorable anatomy for T-TEER, and 37.3% of patients with CCT images were eligible for TTVR. Despite the emergence of TTVR devices, 23.2% of patients with TR remained ineligible for both T-TEER and TTVR.

Keywords: cardiac computed tomography; echocardiography; transcatheter tricuspid valve intervention; transcatheter tricuspid valve replacement; tricuspid regurgitation; tricuspid transcatheter edge-to-edge repair.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Tanaka has received grants from the Japanese College of Cardiology and the Uehara Memorial Foundation; and has received honoraria from Canon Medical Systems. Dr Sugiura has received honoraria for lectures and proctoring from Edwards Lifesciences. Dr Nickenig has received research funding from Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the European Union, Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical; and has received honoraria for lectures or advisory board membership from Abbott, Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr Weber has received lecture or proctoring fees from Abbott and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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