Heart rhythm · 2026
The importance of lead management in the transcatheter tricuspid valve intervention era.
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Beccarino Nicholas J, Goyal Aditya, Ostreicher Zachary, Gabriels James K, Saleh Moussa, Koss Elana, Rutkin Bruce, Epstein Laurence M
Аннотация
BACKGROUND: Percutaneous transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment for severe tricuspid regurgitation (TR). Management of TR in the setting of transvenous leads is complex, requiring a multidisciplinary team-based approach. Transvenous lead extraction (TLE) may improve or worsen lead-related TR and is important when considering TTVR to avoid "jailing" leads between the transcatheter and native tricuspid valve. Data and guidance in these settings are limited.
OBJECTIVE: This study aimed to describe the outcomes of a strategy using TLE in patients with severe TR and a lead crossing the tricuspid valve who were being considered for catheter-based tricuspid valve intervention (TTVR or tricuspid transcatheter edge-to-edge repair).
METHODS: This study included all patients who underwent TLE for TR between July 2020 and July 2025 at a single high-volume extraction center. Demographic characteristics, procedural details, and clinical outcomes were analyzed.
RESULTS: The study included 24 patients, with 14 women (58.3%) with a mean age of 73.7 years, with severe TR and transvenous leads being considered for tricuspid valve intervention. Complete TLE procedural success was achieved in all patients. 11 patients (46%) experienced a reduction in TR after extraction, eliminating the need for further tricuspid intervention in 8 patients (33%). Of the remaining patients, 12 (75%) underwent subsequent tricuspid valve intervention. There were 3 mortalities during the study, none of which were procedure related.
CONCLUSION: In our series, TLE was a safe and efficacious approach to reduce the degree of TR or serve as a bridge to tricuspid intervention.
OBJECTIVE: This study aimed to describe the outcomes of a strategy using TLE in patients with severe TR and a lead crossing the tricuspid valve who were being considered for catheter-based tricuspid valve intervention (TTVR or tricuspid transcatheter edge-to-edge repair).
METHODS: This study included all patients who underwent TLE for TR between July 2020 and July 2025 at a single high-volume extraction center. Demographic characteristics, procedural details, and clinical outcomes were analyzed.
RESULTS: The study included 24 patients, with 14 women (58.3%) with a mean age of 73.7 years, with severe TR and transvenous leads being considered for tricuspid valve intervention. Complete TLE procedural success was achieved in all patients. 11 patients (46%) experienced a reduction in TR after extraction, eliminating the need for further tricuspid intervention in 8 patients (33%). Of the remaining patients, 12 (75%) underwent subsequent tricuspid valve intervention. There were 3 mortalities during the study, none of which were procedure related.
CONCLUSION: In our series, TLE was a safe and efficacious approach to reduce the degree of TR or serve as a bridge to tricuspid intervention.