Surgical Bailout and Retrieval of Maldeployed Transcatheter Tricuspid Valve: Technical Considerations

To discuss the surgical considerations after a maldeployed Evoque transcatheter tricuspid valve replacement system.

1) Secure the delivery system at the groin to prevent further device displacement. 2) Safely access the chest and establish cardiopulmonary bypass; arresting the heart is not required. 3) Release each ventricular anchor sequentially in a rotational pattern. 4) Inspect the native tricuspid valve and decide intraoperatively on repair versus replacement.

Failure to secure the delivery system may risk further device embolization. Central bicaval cannulation may crowd surgical field and make device removal more challenging. Failure to individually free each anchor risks damage to valve leaflets or chordae. Ice-cold saline for nitinol frame risks ventricular arrhythmia in a beating-heart setting and is not necessary.

Transcatheter tricuspid valve replacement maldeployment may warrant emergent surgical conversion. Although not technically challenging, patient comorbidities, prior operations, and location of the device all need to be considered.