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April 30, 2026Annals of Cardiothoracic SurgeryOpen Access

TTVR reduces TR and improves QoL but requires careful selection to mitigate RV failure and conduction risks.

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Why the study?

Predictors of prognosis in patients undergoing transcatheter tricuspid valve replacement (TTVR) remain to be defined.

Population

Patients undergoing transcatheter tricuspid valve replacement (TTVR)

Design

Review

Key result

Transcatheter tricuspid valve replacement provides predictable reduction in tricuspid regurgitation and improves quality of life, but requires careful patient selection to mitigate risks of right ventricular failure and conduction disturbances.

Authors

NFNeil P. FamKKKitae Kim

Discussion

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Overview

Highlights RV assessment needs in TTVR candidates; observational data leave optimal thresholds open for prospective validation.

Key Points

  • To evaluate prognostic factors and outcomes associated with transcatheter tricuspid valve replacement (TTVR) in patients with right heart failure.
  • Analysis of data from the EVOQUE registry
  • Assessment of preoperative right ventricular dysfunction
  • Invasive hemodynamic evaluations to measure pulmonary artery pressures
  • Preoperative RV dysfunction linked to higher in-hospital mortality and poorer clinical follow-up outcomes.
  • Pulmonary artery to RV coupling index ≤ 0.406 associated with adverse outcomes post-TTVR.
  • Invasive assessment helps identify patients at risk of afterload mismatch and right ventricle failure.

Structured PICO

P
Population
Patients undergoing transcatheter tricuspid valve replacement (TTVR)
I
Intervention
Transcatheter tricuspid valve replacement (TTVR)

Advanced RV dysfunction and precapillary pulmonary hypertension should be carefully evaluated before TTVR to avoid post-procedural RV failure and adverse outcomes.

Limitations

  • Data on the long-term valve durability after TTVR are currently lacking.
  • The optimal anticoagulation strategy to prevent valve thrombosis is still uncertain.

Cite This Study

Fam et al. (2026) conducted an editorial in Tricuspid regurgitation. Transcatheter tricuspid valve replacement (TTVR) vs. Medical therapy or transcatheter edge-to-edge repair (TEER) was evaluated. Transcatheter tricuspid valve replacement provides predictable reduction in tricuspid regurgitation and improves quality of life, but requires careful patient selection to mitigate risks of right ventricular failure and conduction disturbances.

synapsesocial.com/papers/6a025e8493868c48f3093d8ahttps://doi.org/10.21037/acs-2025-aw-43-tvd
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