First-in-Human Orthotopic Transcatheter Tricuspid Valve Replacement in a Patient With a Left Ventricular Assist Device

BACKGROUND: Significant tricuspid regurgitation (TR) is common in patients after left ventricular assist device (LVAD) implantation and is associated with an increased risk of mortality. Studies evaluating concomitant surgical tricuspid valve intervention have not consistently demonstrated benefit. FIRST-IN-HUMAN SUMMARY: We describe a first-in-human transcatheter tricuspid valve replacement (TTVR) using the Evoque system in a 46-year-old man with medically refractory, severe TR and right ventricular failure after LVAD implantation. DISCUSSION: Our case demonstrates that TTVR is a technically feasible treatment option for LVAD patients with refractory TR, in this case improving symptoms and reducing the need for chronic inotropic support. NOVELTY: To our knowledge, this is the first report of TTVR using the Evoque valve system in a patient with an LVAD. TAKE-HOME MESSAGES: Patients with severe TR after LVAD implantation have worse outcomes, but surgical tricuspid valve intervention at the time of LVAD implantation has not consistently shown benefit. TTVR platforms may represent a therapeutic alternative for patients with persistent symptomatic TR.