TTVR is a feasible and effective option for managing complex, torrential tricuspid regurgitation related to cardiac implantable electronic device leads.
BACKGROUND: Cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized, necessitating heart team assessment. Transcatheter tricuspid valve replacement (TTVR) is emerging as an option for inoperable patients with TR, requiring decisions on right ventricular lead management. CASE SUMMARY: A 76-year-old woman developed moderate to severe TR after pacemaker implantation, which was exacerbated by a second RV lead 8 years later, leading to torrential TR and recurrent heart failure hospitalizations. TR persisted despite lead extraction, and multimodality imaging revealed complex valve anatomy. TTVR was performed, yielding excellent echocardiographic results and improved quality of life. DISCUSSION: CIED and TR can coexist, obscuring the distinction between lead-related and lead-associated TR because of right ventricular remodeling. The heart team should determine lead management during transcatheter procedures. TTVR is a valuable option for massive gaps, severe tethering, or complex anatomy. TAKE-HOME MESSAGE: Collaborative management with electrophysiology as part of the extended heart team is key in CIED-related TR cases.
Patrascu et al. (Wed,) studied this question.