Practice Patterns and Outcomes for Tricuspid Interventions Among Medicare Patients With Cardiac Implantable Electronic Devices.

BACKGROUND

Given recent approval of percutaneous tricuspid valve devices, clinical evidence is needed to guide lead management (extraction vs "jailing" [ie, entrapping]) for patients with preexisting cardiac implantable electronic devices (CIEDs).

OBJECTIVES

The goal of this study was to describe nationwide trends in both surgical and percutaneous tricuspid interventions and resulting clinical outcomes, particularly for patients with CIEDs.

METHODS

Tricuspid interventions were identified among Medicare beneficiaries with and without CIEDs. In-hospital and 30-day procedural complications were compared with propensity score models. Predictors of CIED extraction were identified with Cox regression.

RESULTS

From 2016 to 2023, a total of 25,910 patients underwent tricuspid interventions, 2,355 (9.2%) of whom had CIEDs. The volume of percutaneous tricuspid interventions increased from <1% in 2016 to 28% in 2023, and patients with CIEDs underwent significantly more percutaneous interventions than patients without CIEDs (17.2% vs 7.9%). Among patients with CIEDs, tricuspid intervention plus extraction was performed in 18.9% of cases. CIED infection was the most common predictor of extraction (35.8%). Overall, patients undergoing tricuspid interventions (with or without CIEDs) had high rates of death (1.1%), shock (14.1%), and bleeding requiring transfusion (8.7%). For patients with CIEDs, concomitant extraction was not associated with more complications compared with no extraction, except for more in-hospital acute kidney injury (adjusted OR: 1.61; 95% CI: 1.31-1.98).

CONCLUSIONS

The nationwide volume of percutaneous tricuspid interventions is increasing, driven primarily by patients with CIEDs, who represent approximately 10% of the tricuspid procedural volume. Concomitant lead extraction was frequently used when clinically indicated and was not associated with higher complications. The high complication rate for all tricuspid interventions suggests that extraction procedures should be deployed cautiously in this population.