Guddeti Raviteja R, Seshiah Puvi, Bae Richard, El-Hangouche Nadia, Costea Alex, Schloss Edward, Yildiz Mehmet, Garcia Santiago
The Carl and Edyth Lindner Research Center at the Christ Hospital, Cincinnati, Ohio, USA.
Struct Heart. 2025 Jul 26;9(9):100707. doi: 10.1016/j.shj.2025.100707. eCollection 2025 Sep.
Severe, untreated tricuspid regurgitation is associated with worse clinical outcomes. While isolated tricuspid valve (TV) surgery has been linked to poor long-term outcomes, transcatheter TV therapies, including edge-to-edge repair and transcatheter tricuspid valve replacement (TTVR), have emerged as effective alternatives and have been shown to improve outcomes, leading to their regulatory approval in the United States. Conduction system abnormalities are commonly seen among patients undergoing TTVR due to the close proximity of the atrioventricular node and the His bundle to the TV annulus. In the TRISCEND II (Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device) trial, 38% of the patients had prior cardiac implantable electronic devices (CIEDs), while 25% of patients developed new conduction abnormalities necessitating implantation of new CIEDs. Concerns exist regarding trapping existing CIED leads during TTVR. Similarly, transvenous permanent pacemaker implantation post-TTVR has been reported to be associated with valve dysfunction. In this case-based narrative review, we describe case examples of patients with prior CIEDs undergoing TTVR and conduction abnormalities post-TTVR needing a new permanent pacemaker and discuss potential periprocedural strategies for optimal outcomes. Electrophysiologists specializing in periprocedural management of CIEDs, including lead extraction and post-TTVR device management, play a crucial role and should be part of a comprehensive heart team approach for optimal outcomes.
严重的、未经治疗的三尖瓣反流与更差的临床结局相关。虽然单纯三尖瓣手术与不良的长期结局有关，但经导管三尖瓣治疗，包括缘对缘修复和经导管三尖瓣置换术（TTVR），已成为有效的替代方法，并已被证明能改善结局，从而在美国获得监管批准。由于房室结和希氏束与三尖瓣环距离很近，传导系统异常在接受TTVR的患者中很常见。在TRISCEND II（经导管三尖瓣置换术：使用新型装置的安全性和临床疗效关键临床研究）试验中，38%的患者曾有心脏植入式电子设备（CIED），而25%的患者出现新的传导异常，需要植入新的CIED。人们担心在TTVR过程中会困住现有的CIED导线。同样，据报道TTVR后经静脉植入永久性起搏器与瓣膜功能障碍有关。在这篇基于病例的叙述性综述中，我们描述了有既往CIED的患者接受TTVR以及TTVR后出现传导异常需要新的永久性起搏器的病例，并讨论了为实现最佳结局的潜在围手术期策略。专门从事CIED围手术期管理（包括导线拔除和TTVR后设备管理）的电生理学家发挥着关键作用，应该成为全面心脏团队方法的一部分以实现最佳结局。
