Transcatheter Tricuspid Valve Replacement Using Conscious Sedation and Intracardiac Echocardiography

Transcatheter aortic valve replacement is routinely performed with a "minimalist approach" using conscious sedation. Conversely, transcatheter tricuspid valve replacement (TTVR) is performed with general anesthesia using transesophageal echocardiography. Performing TTVR using conscious sedation and intracardiac echocardiography (ICE) alone has not been described.

We present a patient with NYHA functional class III symptoms secondary to severe tricuspid regurgitation. Our team deemed the patient at high risk for surgical therapy and decided that TTVR with the Evoque system would be ideal. With monitored anesthesia care, imaging was performed using three-dimensional ICE. Evoque positioning and deployment was uneventful, with normal anchoring and trivial central tricuspid regurgitation.

It is feasible to perform Evoque TTVR with a minimalist approach using conscious sedation and ICE.

In select patients, TTVR with Evoque using conscious sedation and ICE alone is possible.