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Practice Patterns and Outcomes for Tricuspid Interventions Among Medicare Patients With Cardiac Implantable
Enrico G Ferro1, Lorenzo V Arvanitis2, Siling Li3
1Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Clinical Electrophysiology
|November 7, 2025
Summary
Percutaneous tricuspid interventions are rising, especially in patients with cardiac implantable electronic devices (CIEDs). Lead extraction during these procedures is common and safe, but overall complication rates remain high.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Growing use of percutaneous tricuspid valve devices necessitates evidence for managing pre-existing cardiac implantable electronic devices (CIEDs).
- Optimal lead management strategies (extraction vs. "jailing") for CIED patients undergoing tricuspid interventions require clarification.
Purpose of the Study:
- To analyze national trends in surgical and percutaneous tricuspid interventions.
- To evaluate clinical outcomes, focusing on patients with CIEDs.
- To identify factors influencing lead extraction decisions.
Main Methods:
- Retrospective analysis of Medicare beneficiaries undergoing tricuspid interventions (2016-2023).
- Comparison of in-hospital and 30-day outcomes using propensity score matching.
- Cox regression analysis to determine predictors of CIED extraction.
Main Results:
- Percutaneous tricuspid interventions increased significantly, with CIED patients more likely to undergo these procedures (17.2% vs. 7.9%).
- CIED extraction occurred in 18.9% of CIED patients, with infection being a primary driver (35.8%).
- Concomitant extraction did not increase overall complications, except for acute kidney injury (aOR 1.61).
Conclusions:
- Percutaneous tricuspid interventions are increasingly adopted, particularly by patients with CIEDs.
- Lead extraction is frequently employed when indicated and does not elevate complication risks, barring acute kidney injury.
- High overall complication rates for tricuspid interventions warrant cautious application of extraction procedures.
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