The importance of lead management in the transcatheter tricuspid valve intervention era.

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.