Why the study?
Determinants of early prosthetic thrombosis following transcatheter tricuspid valve replacement are unknown.
Early interruption of anticoagulation after TTVR may lead to severe prosthetic thrombosis, and subsequent surgical explantation can damage native structures, necessitating valve replacement rather than repair.
BACKGROUND: Determinants of early prosthetic thrombosis following transcatheter tricuspid valve replacement (TTVR) are unknown. CASE SUMMARY: A 70-year-old man with severe tricuspid regurgitation underwent an uneventful TTVR using the EVOQUE system (Edwards Lifesciences). Intravenous heparin was temporarily suspended a few days after the procedure to insert a permanent pacemaker. Sudden clinical deterioration occurred in the following days. Echocardiography demonstrated extensive thrombosis of the TTVR prosthesis, requiring surgical removal. Tricuspid valve repair was not possible because of the anchoring mechanism of the prosthesis, and a tricuspid valve replacement was necessary. The patient's postoperative course was unremarkable. DISCUSSION: The optimal management of anticoagulation in patients undergoing TTVR needs to be elucidated. TAKE-HOME MESSAGES: Early interruption of anticoagulation after TTVR may be associated with severe prosthetic thrombosis in selected high-risk patients. Surgical TTVR explantation may damage the native tricuspid leaflets and subvalvular apparatus, reducing the likelihood of valve repair.
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Trinca et al. (2026) studied this question.
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