Key result
Transvenous lead extraction is linked to reduced TR in ~46% of patients with severe regurgitation.
Why the study?
Managing severe TR with transvenous leads is complex, and data and guidance on lead extraction when considering transcatheter tricuspid interventions are limited.
Does transvenous lead extraction reduce tricuspid regurgitation severity or facilitate subsequent intervention in patients with severe TR and transvenous leads?
Observational (n=24)
No
Does transvenous lead extraction reduce tricuspid regurgitation severity or facilitate subsequent intervention in patients with severe TR and transvenous leads?
Transvenous lead extraction prior to planned tricuspid valve intervention is safe, highly successful, and can reduce TR severity enough to eliminate the need for further valve intervention in a third of patients.
Reassuring for TLE feasibility in selected patients; leaves open broader efficacy, safety, and TR impact pending larger trials.
BACKGROUND: Percutaneous transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment for severe tricuspid regurgitation (TR). Management of TR in the setting of transvenous leads is complex, requiring a multidisciplinary team-based approach. Transvenous lead extraction (TLE) may improve or worsen lead related TR and is important when considering TTVR to avoid "jailing" leads between the transcatheter and native tricuspid valve. Data and guidance in these settings are limited. OBJECTIVE: Our objective was to describe the outcomes of a strategy using TLE in patients with severe TR and a lead crossing the tricuspid valve that were being considered for catheter based tricuspid valve intervention (TTVR or tTEER). METHODS: This study included all patients who underwent TLE for TR between July 2020 and July 2025 at a single high volume extraction center. Demographic characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: The study included 24 patients, 14 (58.3%) women with a mean age of 73.7 years, with severe TR and transvenous leads being considered for tricuspid valve intervention. Complete TLE procedural success was achieved in all patients. Eleven patients (46%) experienced reduction in TR post extraction, eliminating the need for further tricuspid intervention in 8 patients (33%). Of the remaining patients, 12 (75%) underwent subsequent tricuspid valve intervention. There were three mortalities during the study, none of which were procedure related. CONCLUSION: In our series, TLE was a safe and efficacious approach to reduce the degree of TR or serve as a bridge to tricuspid intervention.
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Beccarino et al. (2026) conducted an observational in Severe tricuspid regurgitation with transvenous leads (n=24). Transvenous lead extraction (TLE) was evaluated on Complete TLE procedural success. Transvenous lead extraction achieved 100% procedural success in patients with severe tricuspid regurgitation, reducing TR in 46% of patients and eliminating the need for further intervention in 33%.
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