# Transcatheter tricuspid valve replacement with EVOQUE™ in arrhythmogenic right ventricular cardiomyopathy: insights from the first-in-man case report

## TL;DR

This case report describes the first successful transcatheter tricuspid valve replacement in a patient with arrhythmogenic right ventricular cardiomyopathy and severe tricuspid regurgitation.

## Contribution

The first-in-man case demonstrates the feasibility of TTVR using the EVOQUE™ system in complex ARVC patients with prior failed repair.

## Key findings

- TTVR with the EVOQUE™ system eliminated tricuspid regurgitation and improved symptoms in a patient with ARVC.
- The procedure highlights the importance of pre-procedural planning and intra-procedural imaging to prevent right heart failure.
- This case supports TTVR as a potential bridge-to-transplant strategy for patients unsuitable for surgery or TEER.

## Abstract

Severe functional tricuspid regurgitation (TR) in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVC) represents a challenging clinical entity, often complicated by progressive right ventricular (RV) dysfunction and limited interventional options.

We report the first worldwide case of successful transcatheter tricuspid valve replacement (TTVR) with the EVOQUE™ system in a 37-year-old patient with ARVC, severe TR, and a cardiac resynchronization therapy defibrillator (CRT-D), following failed transcatheter edge-to-edge repair (TEER). The procedure resulted in immediate elimination of TR and the patient experienced marked symptomatic improvement.

This case highlights the feasibility of TTVR in complex RV pathology, underscoring procedural considerations such as lead–valve interaction, risk of afterload mismatch, and prevention of right heart failure. TTVR with the EVOQUE™ system is feasible in selected patients with ARVC, severe functional TR, prior failed repair, and existing CRT-D leads. Success depends on meticulous pre-procedural planning, intra-procedural imaging, and vigilant haemodynamic management to mitigate RHF risk. This case broadens the spectrum of structural interventions in patients with ARVC and symptomatic TR not suitable for surgery or TEER and supports consideration of TTVR as a bridge-to-transplant strategy.