Transcatheter Tricuspid Valve Replacement for Residual Tricuspid Regurgitation After TEER

BACKGROUND: Residual or recurrent tricuspid regurgitation (TR) after prior transcatheter tricuspid edge-to-edge (T-TEER) repair occurs in about 12% of patients within 1 year. Since surgical tricuspid valve repair or replacement is of high risk, treatment options remain scarce. Data regarding the feasibility, safety, and treatment strategies using transcatheter valve replacement (TTVR) after T-TEER are sparse. AIMS: Here, we aimed to summarize our early experience in TTVR after failed T-TEER, analyze its feasibility and summarize the results in a distinct algorithm. METHODS: Patients undergoing TTVR (n = 21) at the University Hospital of Duesseldorf were prospectively analyzed and stratified according prior T-TEER procedures with implanted devices. Groups were compared in terms of procedural success, periprocedural complications, and patient outcomes. Individual treatment decisions for patients after T-TEER were analyzed. RESULTS: Five patients had residual/recurrent severe to torrential TR and underwent TTVR after T-TEER, whereas 16 patients were primarily referred for TTVR. Preprocedural wire-based intentional clip excision (WICE) was performed in 60% of these patients. Patients did not differ regarding procedural success (100% in both groups, p = 0.99) and periprocedural complications (0 [TTVR after TEER] vs. 5.6% [primary TTVR], p = 0.99 for the combined endpoint of in-hospital death, stroke, myocardial infarction, re-intervention or surgery, and major bleeding). A pacemaker was required in one patient of each group, p = 0.4). Procedural times were higher among patients with prior T-TEER. Treatment decisions for patients after T-TEER were integrated into a treatment algorithm. CONCLUSION: The valve after clip concept is feasible and the proposed algorithm may support procedural planning.