Transcatheter Tricuspid Valve Replacement After Failed Transcatheter Annuloplasty and Edge-to-Edge Repair

The EVOQUE transcatheter tricuspid heart valve (Edwards Lifesciences) is approved for high-risk patients with severe tricuspid regurgitation (TR). This report describes the first EVOQUE implantation after failed percutaneous tricuspid annuloplasty and edge-to-edge repair.

An 80-year-old man with atrial fibrillation underwent percutaneous annuloplasty with a Cardioband (Edwards Lifesciences) for torrential TR. Initially improved, TR recurred within a year, accompanied by severe mitral regurgitation. The patient underwent mitral and tricuspid edge-to-edge repairs, improving symptoms to NYHA functional class II, but TR persisted because of a large coaptation gap. Three years later, TR worsened as a result of single-leaflet device attachment. After multidisciplinary evaluation, transcatheter tricuspid valve replacement (TTVR) with a 48-mm EVOQUE valve was performed successfully. At 1 month, the patient had no residual TR, mild paravalvular leak, and NYHA functional class II status.

This case highlights TTVR's feasibility for severe TR, even after failed annuloplasty and edge-to-edge repair, thereby expanding options for complex cases.

TTVR offers a viable treatment option for complex TR cases even after failed annuloplasty and edge-to-edge repair.