Transcatheter Tricuspid Valve Embolization: Revealing Critical Limitations of Contemporary Valve Design

Edwards Lifesciences' Evoque valve system is the only approved transcatheter system for tricuspid valve replacement (TTVR). Two major studies have shown remarkable improvements in quality of life after the Evoque valve replacement, and a 2-year follow-up suggested a mortality benefit.

A 64-year-old woman with severe symptomatic tricuspid valve regurgitation underwent implantation of an Evoque valve. Following the procedure, she developed frequent cardiac arrhythmia. Subsequent transthoracic and transesophageal echocardiograms demonstrated valve embolization. Intraoperative observation further revealed that a large ventricular septal defect was created by the displaced valve.

TTVR carries significant risks; valve migration can result in life-threatening complications, requiring immediate surgical evaluation. This report is the first to document a life-threatening valve embolization, indicating that the valve design remains suboptimal.

The current TTVR system design is inadequate. Valve migration is a potentially life-threatening complication that exposes fundamental flaws in the existing device design.