Transcatheter tricuspid valve replacement safe with trans-tricuspid valve pacemaker lead
Transcatheter tricuspid valve replacement in patients with trans-tricuspid valve pacemaker leads without re-replacement or lead extraction was safe with low risk for complications, researchers found.
“Although longer follow-up will be necessary to determine whether patients who undergo transcatheter tricuspid valve replacement in the setting of transvenous pacing leads are at risk for accelerated valve dysfunction, there is no obvious reason for concern on the basis of the evidence in this preliminary experience,” Jason H. Anderson, MD, echocardiographer, interventional cardiologist and pediatric cardiologist at Mayo Clinic, and colleagues wrote.
VIVID registry data
In this study published in JACC: Cardiovascular Interventions, researchers analyzed data from 329 patients from the Valve-in-Valve International Database (VIVID) registry who underwent transcatheter tricuspid valve replacement after tricuspid valve replacement or repair.
Patients were categorized as transvenous lead (n = 58; median age at transcatheter tricuspid valve replacement procedure, 56 years; 64% women), epicardial lead (n = 70; median age at transcatheter tricuspid valve replacement procedure, 31 years; 70% women) or no lead (n = 201; median age at transcatheter tricuspid valve replacement procedure, 40 years; 52% women). Patients with transvenous pacemaker leads were further categorized as entrapped (n = 28; median age at transcatheter tricuspid valve replacement procedure, 60 years; 75% women) or not entrapped (n = 30; median age at transcatheter tricuspid valve replacement procedure, 53 years; 53% women).
The primary outcome for this study was lead-related complications during transcatheter tricuspid valve replacement, which included lead dislodgement and lead fracture.
There were 31 patients with leads that passed through the tricuspid valve. Before transcatheter tricuspid valve replacement, three patients had a right ventricular lead extracted.
In patients with an entrapped RV lead, they were entrapped between the transcatheter tricuspid valve implant and the surgical valve (n = 22) or the repaired tricuspid valve (n = 6). RV lead displacement occurred in one patient during the procedure, and lead failure was observed in two patients during follow-up.
Patients with and without pacing leads or entrapped RV leads did not have significant differences in the cumulative incidences of tricuspid valve reintervention, tricuspid valve dysfunction or death.
“Although low, there is a risk for lead failure after transcatheter tricuspid valve replacement, for which ongoing evaluation of the lead threshold and impedance testing should be performed,” Anderson and colleagues wrote.
Replacement vs. surgery
In a related editorial, Can Öztürk, MD, of the Heart Center at the University Hospital Bonn in Germany, and colleagues wrote: “Taken together, first, the investigators are to be congratulated for this report. It is the first of its kind and provides novel data for this important patient group. Second, in this highly morbid patient group, redo transcatheter tricuspid valve replacement appears promising and more attractive than surgical open-heart procedures. However, regarding tricuspid valve surgery, there have been innovative further developments with respect to beating-heart and minimally invasive procedures, which also have to be considered.”