Clinical study and comprehensive management strategies of complications related to transcatheter tricuspid valve therapy_West China Medical Journal

Authors：

NING Xiaoping ,  QIAO Fan

Department of Cardiovascular Surgery, Changhai hospital affiliated to the Naval Medical University, Shanghai 200433, P. R. China;

Corresponding?author：

QIAO Fan, Email: qiaofan@smmu.edu.cn

Keywords：

Tricuspid regurgitation; transcatheter; complication; prevention and control

DOI：

10.7507/1002-0179.202509145

Video：

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With the advancement of interventional cardiology, transcatheter tricuspid valve intervention has become an important treatment option for patients with severe tricuspid regurgitation who are at high surgical risk. This article provides a systematic summary of the types, incidence, risk factors, and management strategies of complications related to transcatheter tricuspid valve repair and replacement. This article also discusses the pathophysiological mechanisms and preventive measures of right heart dysfunction, device malanchoring, and renal impairment. Multimodality imaging, device innovation, and individualized anticoagulation strategies are crucial for reducing complications. Long-term follow-up data are needed to refine complication management strategies and promote the safe application of transcatheter tricuspid valve intervention.

1.	Nath J, Foster E, Heidenreich P A. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
2.	Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol, 2017, 70(24): 2953-2960.
3.	Davidson LJ, Tang GHL, Ho EC, et al. The tricuspid valve: a review of pathology, imaging, and current treatment options: a scientific statement from the american heart association. Circulation, 2024, 149(22): e1223-e1238.
4.	Lu FL, An Z, Ma Y, et al. Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. Heart, 2021, 107(20): 1664-1670.
5.	Angellotti D, Mattig I, Samim D, et al. Early outcomes of real-world transcatheter tricuspid valve replacement. JACC Cardiovasc Interv, 2025, 18(15): 1896-1909.
6.	Pan X, Lu F, Wang Y, et al. Transcatheter tricuspid valve replacement with the novel system: 1-year outcomes from the TRAVEL study. JACC Cardiovasc Interv, 2025, 18(10): 1276-1285.
7.	Lurz P, Rommel KP, Schmitz T, et al. Real-World 1-Year Results of Tricuspid Edge-to-Edge Repair From the bRIGHT Study. J Am Coll Cardiol, 2024, 84(7): 607-616.
8.	Davidson CJ, Lim DS, Smith RL, et al. Early Feasibility Study of Cardioband Tricuspid System for Functional Tricuspid Regurgitation: 30-Day Outcomes. JACC Cardiovasc Interv, 2021, 14(1): 41-50.
9.	Rangavajla G, Patel R, Nguyen F, et al. Atrioventricular block after EVOQUE transcatheter tricuspid valve replacement. Struct Heart, 2025, 9(9): 100701.
10.	Teiger E, Nejjari M, Lim P, et al. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system. EuroIntervention, 2022, 18(10): 862-864.
11.	Bu?an B, ?ekirdek?i E?, Onar L?, et al. Transcatheter tricuspid valve replacement for tricuspid regurgitation: a systematic review and meta-analysis. Anatol J Cardiol, 2022, 26(7): 505-519.
12.	Kodali S, Hahn RT, George I, et al. Transfemoral tricuspid valve replacement in patients with tricuspid regurgitation: TRISCEND study 30-day results. JACC Cardiovasc Interv, 2022, 15(5): 471-480.
13.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery. Anesthesiology, 2019, 131(5): 1046-1062.
14.	王渝強, 石峻, 劉路路, 等. 經導管三尖瓣介入術后肺部并發癥的初次探索及康復建議: 前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2022, 29(8): 963-970.
15.	Safi LM, Lerakis S, Tang GHL, et al. Intraprocedural guidance for transcatheter tricuspid valve replacement in challenging scenarios. JACC Cardiovasc Imaging, 2025, 18(3): 382-388.
16.	Tanaka T, Vogelhuber J, ?ztürk C, et al. Eligibility for transcatheter tricuspid valve interventions in patients with tricuspid regurgitation. JACC Cardiovasc Interv, 2024, 17(23): 2732-2744.
17.	Ger?ek M, Goncharov A, Narang A, et al. Characterization of screen failures among patients evaluated for transcatheter tricuspid valve repair (TriSelect-Study). JACC Cardiovasc Interv, 2023, 16(13): 1579-1589.
18.	Weckbach LT, Stolz L, Doldi PM, et al. Relevance of residual tricuspid regurgitation for right ventricular reverse remodelling after tricuspid valve intervention in patients with severe tricuspid regurgitation and right-sided heart failure. Eur J Heart Fail, 2024: doi: 10.1002/ejhf.3529.
19.	Lurz P, Orban M, Besler C, et al. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair. Eur Heart J, 2020, 41(29): 2785-2795.
20.	Hahn RT, Kodali S, Fam N, et al. Early multinational experience of transcatheter tricuspid valve replacement for treating severe tricuspid regurgitation. JACC Cardiovasc Interv, 2020, 13(21): 2482-2493.
21.	Dreyfus J, Audureau E, Bohbot Y, et al. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J, 2022, 43(7): 654-662.
22.	Zorman MJ, Vibhishanan J, Dangas K, et al. Subclinical and clinical valve thrombosis after transcatheter tricuspid valve replacement: a systematic review and meta-analysis. JACC Cardiovasc Interv, 2025, 18(11): 1495-1497.
23.	Braunstein ED, Simsolo E, Kassam N, et al. Cardiac implantable electronic device implantation and function after transcatheter tricuspid valve replacement. Heart rhythm, 2025: S1547-5271(25)02730-4.
24.	Peigh G, Al-Kazaz M, Davidson LJ, et al. Outcomes of entrapped right ventricular pacing or defibrillator leads following transcatheter tricuspid valve replacement. JACC Cardiovasc Interv, 2025, 18(14): 1762-1772.
25.	Patrascu A, Binder D, Al Farwan F, et al. Two ‘firsts’ in a patient with tricuspid valve infective endocarditis following edge-to-edge repair: a case report. Eur Heart J Case Rep, 2024, 8(4): ytae181.
26.	Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
27.	Enriquez-Sarano M, Messika-Zeitoun D, Topilsky Y, et al. Tricuspid regurgitation is a public health crisis. Prog Cardiovasc Dis, 2019, 62(6): 447-451.
28.	Stolz L, Fam N, Ong G, et al. Transcatheter tricuspid valve replacement using the LuX-Valve Plus system: 1-year compassionate use outcomes. Eur J Heart Fail, 2025. doi: 10.1002/ejhf.70010.

1. Nath J, Foster E, Heidenreich P A. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
2. Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol, 2017, 70(24): 2953-2960.
3. Davidson LJ, Tang GHL, Ho EC, et al. The tricuspid valve: a review of pathology, imaging, and current treatment options: a scientific statement from the american heart association. Circulation, 2024, 149(22): e1223-e1238.
4. Lu FL, An Z, Ma Y, et al. Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation. Heart, 2021, 107(20): 1664-1670.
5. Angellotti D, Mattig I, Samim D, et al. Early outcomes of real-world transcatheter tricuspid valve replacement. JACC Cardiovasc Interv, 2025, 18(15): 1896-1909.
6. Pan X, Lu F, Wang Y, et al. Transcatheter tricuspid valve replacement with the novel system: 1-year outcomes from the TRAVEL study. JACC Cardiovasc Interv, 2025, 18(10): 1276-1285.
7. Lurz P, Rommel KP, Schmitz T, et al. Real-World 1-Year Results of Tricuspid Edge-to-Edge Repair From the bRIGHT Study. J Am Coll Cardiol, 2024, 84(7): 607-616.
8. Davidson CJ, Lim DS, Smith RL, et al. Early Feasibility Study of Cardioband Tricuspid System for Functional Tricuspid Regurgitation: 30-Day Outcomes. JACC Cardiovasc Interv, 2021, 14(1): 41-50.
9. Rangavajla G, Patel R, Nguyen F, et al. Atrioventricular block after EVOQUE transcatheter tricuspid valve replacement. Struct Heart, 2025, 9(9): 100701.
10. Teiger E, Nejjari M, Lim P, et al. First-in-human implantation of the Topaz transcatheter tricuspid valve replacement system. EuroIntervention, 2022, 18(10): 862-864.
11. Bu?an B, ?ekirdek?i E?, Onar L?, et al. Transcatheter tricuspid valve replacement for tricuspid regurgitation: a systematic review and meta-analysis. Anatol J Cardiol, 2022, 26(7): 505-519.
12. Kodali S, Hahn RT, George I, et al. Transfemoral tricuspid valve replacement in patients with tricuspid regurgitation: TRISCEND study 30-day results. JACC Cardiovasc Interv, 2022, 15(5): 471-480.
13. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery. Anesthesiology, 2019, 131(5): 1046-1062.
14. 王渝強, 石峻, 劉路路, 等. 經導管三尖瓣介入術后肺部并發癥的初次探索及康復建議: 前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2022, 29(8): 963-970.
15. Safi LM, Lerakis S, Tang GHL, et al. Intraprocedural guidance for transcatheter tricuspid valve replacement in challenging scenarios. JACC Cardiovasc Imaging, 2025, 18(3): 382-388.
16. Tanaka T, Vogelhuber J, ?ztürk C, et al. Eligibility for transcatheter tricuspid valve interventions in patients with tricuspid regurgitation. JACC Cardiovasc Interv, 2024, 17(23): 2732-2744.
17. Ger?ek M, Goncharov A, Narang A, et al. Characterization of screen failures among patients evaluated for transcatheter tricuspid valve repair (TriSelect-Study). JACC Cardiovasc Interv, 2023, 16(13): 1579-1589.
18. Weckbach LT, Stolz L, Doldi PM, et al. Relevance of residual tricuspid regurgitation for right ventricular reverse remodelling after tricuspid valve intervention in patients with severe tricuspid regurgitation and right-sided heart failure. Eur J Heart Fail, 2024: doi: 10.1002/ejhf.3529.
19. Lurz P, Orban M, Besler C, et al. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair. Eur Heart J, 2020, 41(29): 2785-2795.
20. Hahn RT, Kodali S, Fam N, et al. Early multinational experience of transcatheter tricuspid valve replacement for treating severe tricuspid regurgitation. JACC Cardiovasc Interv, 2020, 13(21): 2482-2493.
21. Dreyfus J, Audureau E, Bohbot Y, et al. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J, 2022, 43(7): 654-662.
22. Zorman MJ, Vibhishanan J, Dangas K, et al. Subclinical and clinical valve thrombosis after transcatheter tricuspid valve replacement: a systematic review and meta-analysis. JACC Cardiovasc Interv, 2025, 18(11): 1495-1497.
23. Braunstein ED, Simsolo E, Kassam N, et al. Cardiac implantable electronic device implantation and function after transcatheter tricuspid valve replacement. Heart rhythm, 2025: S1547-5271(25)02730-4.
24. Peigh G, Al-Kazaz M, Davidson LJ, et al. Outcomes of entrapped right ventricular pacing or defibrillator leads following transcatheter tricuspid valve replacement. JACC Cardiovasc Interv, 2025, 18(14): 1762-1772.
25. Patrascu A, Binder D, Al Farwan F, et al. Two ‘firsts’ in a patient with tricuspid valve infective endocarditis following edge-to-edge repair: a case report. Eur Heart J Case Rep, 2024, 8(4): ytae181.
26. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
27. Enriquez-Sarano M, Messika-Zeitoun D, Topilsky Y, et al. Tricuspid regurgitation is a public health crisis. Prog Cardiovasc Dis, 2019, 62(6): 447-451.
28. Stolz L, Fam N, Ong G, et al. Transcatheter tricuspid valve replacement using the LuX-Valve Plus system: 1-year compassionate use outcomes. Eur J Heart Fail, 2025. doi: 10.1002/ejhf.70010.

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