Document resource
Background Transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment in addition to medical therapy in severe or greater tricuspid regurgitation (TR). Patients undergoing orthotopic TTVR frequently present with a cardiac implantable electronic device (CIED) lead across the tricuspid valve (TV).Aims We sought to investigate the clinical, procedural and lead-related outcomes for patients with a CIED lead across the TV during orthotopic TTVR.Methods All consecutive patients enrolled in the multicenter TRIPLACE registry ( NCT06033274) were included for analysis. TTVR was performed at 19 centers using 8 different platforms between June 2018 and April 2025. 60 patients had sufficient data allowing lead function parameter analysis. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion.Results Baseline demographic, clinical, procedural and CIED lead characteristics are outlined in table 1. Procedural, follow-up and CIED lead outcome data are outlined in table 2. Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual TR (82.6% vs. 91.4%, p<0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs. 7.1%, p<0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. Univariable Fine-Gray competing risks regression analysis results, identifying predictors of lead failure, are outlined in table 3. No significant increase in adverse events or mortality was observed at 30 days.Abstract 29 Table 1Abstract 29 Table 2Abstract 29 Table 3Conclusion Orthotopic TTVR in patients can be safely and effectively performed in the presence of a transvalvular CIED lead with low rates of lead failure. Significant paravalvular leak and residual TR is more common with a jailed lead. These patients require close CIED follow up with alternative pacing strategies in place, particularly when pacing dependent.