Step-by-Step Transcatheter Tricuspid Valve Replacement Using the LuX-Valve Plus System

The LuX-Valve Plus is a novel radial force-independent orthotopic transjugular transcatheter tricuspid valve replacement device proven to be effective in TR reduction. We describe preprocedural assessment for eligibility and procedural planning by means of computed tomography as well as procedural steps of device implantation under multimodality imaging guidance including transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and fluoroscopy: steering into the right ventricle, leaflet capture by graspers, fine valve adjustment, and septal anchor deployment. Potential pitfalls are avoided by achieving optimal alignment by means of TEE multiplanar reconstruction to steer the delivery system, and using mid-esophageal and deep gastric views of 3-dimensional TEE and supplementary ICE to visualize the graspers for leaflet capture, especially when TEE imaging is technically challenging. In the presence of paravalvular leak after valve deployment, use fine adjustment functions to optimize the result before final release.