Key result
Surgical bailout and retrieval of a maldeployed Evoque TTVR system involves specific surgical considerations.
Why the study?
Surgical considerations and techniques for managing maldeployment of the Evoque transcatheter tricuspid valve replacement system require clarification.
Outlines critical surgical steps and pitfalls for managing a maldeployed transcatheter tricuspid valve, emphasizing the need for careful anchor release and avoidance of ice-cold saline on a beating heart.
Urges preprocedural surgical backup in transcatheter tricuspid procedures; hypothesis-generating for standardized retrieval protocols.
OBJECTIVE: To discuss the surgical considerations after a maldeployed Evoque transcatheter tricuspid valve replacement system. KEY STEPS: 1) Secure the delivery system at the groin to prevent further device displacement. 2) Safely access the chest and establish cardiopulmonary bypass; arresting the heart is not required. 3) Release each ventricular anchor sequentially in a rotational pattern. 4) Inspect the native tricuspid valve and decide intraoperatively on repair versus replacement. POTENTIAL PITFALLS: Failure to secure the delivery system may risk further device embolization. Central bicaval cannulation may crowd surgical field and make device removal more challenging. Failure to individually free each anchor risks damage to valve leaflets or chordae. Ice-cold saline for nitinol frame risks ventricular arrhythmia in a beating-heart setting and is not necessary. TAKE-HOME MESSAGES: Transcatheter tricuspid valve replacement maldeployment may warrant emergent surgical conversion. Although not technically challenging, patient comorbidities, prior operations, and location of the device all need to be considered.
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JOHNSON et al. (2026) conducted a review in Maldeployed transcatheter tricuspid valve replacement. Surgical bailout and retrieval was evaluated. Surgical bailout for maldeployed transcatheter tricuspid valves requires securing the delivery system, establishing cardiopulmonary bypass, and sequentially releasing ventricular anchors.
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