This is an off-label use of transcatheter valves in treating tricuspid regurgitation for those with prior surgical repair consisting of incomplete rings (all but one patient). In total, 22 patients underwent catheterization with the intent for TVIR implantation and achieved procedural success in 20 patients (90%). Despite a sick population, there were no procedural deaths; most were NYHA functional class III or IV (90%), and 26% were acutely ill. Two patients experienced implant malposition – one requiring hybrid retrieval, then repeat transcatheter TVIR implantation, then another malposition with severe paravalvular leak (PVL) post-procedure, requiring a second TVIR implantation.   

 PVL was common post-procedure, occurring in 15 patients (75%) though the majority (n=9) was considered trivial or mild. PVL was treated in 4 patients at the time of index TVIR implant – via a device in 3 and by second TVIR implant in 1 patient. The authors encouraged performing balloon sizing before TVIR implantation to assess the actual dimensions, potential changes in geometry with expansion, and any residual tricuspid regurgitation – the latter portending residual PVL following TVIR implantation. A median of 12 months after implant, improvement in functional capacity was noted in most patients, and no patients had more than mild tricuspid regurgitation on echocardiographic evaluation. Previously limited to case reports and small case series, all interventional cardiologists should know the descriptive analyses and outcomes reported by this registry for TVIR implantation in treating tricuspid regurgitation. This paper sheds light on the unique challenges during this procedure and potential outcomes that may necessitate further intervention. 

All editors: R. Allen Ligon, Jr., MD, FSCAI