Successful implantation of an EVOQUE-tricuspid valve replacement system in a patient with two right ventricular implantable cardioverter-defibrillator leads: a case report

TL;DR

A new method for replacing a tricuspid heart valve was successfully used in a patient with complex heart conditions and implanted devices.

Contribution

Demonstrates the feasibility of EVOQUE-tricuspid valve replacement in patients with multiple ICD leads and limited imaging visibility.

Findings

EVOQUE-tricuspid valve replacement was successfully implanted in a high-risk patient with torrential TR.

ICD function was preserved without significant paravalvular leakage after the procedure.

The case shows the system's potential in challenging anatomical and device-related scenarios.

Abstract

Tricuspid regurgitation (TR) is a disease with significant morbidity and mortality rates. Besides surgery and transcatheter edge-to-edge repair (TEER), transcatheter tricuspid valve replacement has evolved as a possible treatment option in high-risk patients with an unfavourable anatomy for TEER.

We present a case of an 82-year-old patient with torrential TR due to an annulus dilation and subsequent central gap of >8 mm. Echocardiographic guiding was impeded by the presence of two permanent right ventricular implantable cardioverter-defibrillator (ICD) leads and previous surgical aortic valve implantation and mitral valve reconstruction. An EVOQUE prosthesis (Edwards Lifesciences; Irvine, USA) was successfully implanted without impairment of the ICD function or significant paravalvular leakage.

Transcatheter tricuspid valve replacement with the EVOQUE-tricuspid valve replacement system is feasible even in patients with two right ventricular ICD leads and limited echocardiographic visibility.

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