Acute right ventricular response to transcatheter tricuspid valve replacement
Year: 2026
Type: article
Abstract: BACKGROUND: Changes in right ventricular (RV) function are frequent after transcatheter tricuspid valve replacement (TTVR), yet their mechanisms and prognostic implications remain incompletely defined. AIMS: We sought to characterise acute RV functional changes following TTVR and evaluate their prognostic impact. METHODS: This multicentre study included consecutive patients treated with TTVR between 2019 and 2025 with complete imaging data. RV function was assessed by echocardiography at baseline, intraprocedurally, and before discharge. RV end-systolic elastance (Ees), effective arterial elastance (Ea), and RV-pulmonary artery coupling (Ees/Ea) were derived from non-invasive single-beat pressure-volume loop analysis. Changes over time were assessed using paired tests, and associations with mortality were investigated using Cox regression analysis with Firth’s penalised likelihood. RESULTS: Sixty-seven patients (median age 78 years; 72% female; EVOQUE n=49; LuX-Valve Plus n=18) were included. At discharge, both cohorts showed declines in absolute RV free-wall longitudinal strain (aRV-FWLS; -10.4%; p<0.001 for EVOQUE; -10.4%; p=0.001 for LuX-Valve Plus) and fractional area change (FAC; -18.0%; p<0.001 for EVOQUE; -13.5%; p=0.005 for LuX-Valve Plus). Overall, 58% of patients met the criteria for severe RV dysfunction after TTVR. Over a median follow-up of 19 months, 15 patients died. Device type, acute RV functional changes, Ees, and Ees/Ea were not associated with mortality (allp>0.05). In contrast, computed tomography-derived RV coupling (hazard ratio [HR] 0.02, 95% confidence interval [CI]: 0.01-0.89) and the coexistence of baseline longitudinal (tricuspid annular plane systolic excursion <17 mm and/or aRV-FWLS <23%) and circumferential (RV-FAC <=35%) RV dysfunction (HR 3.93, 95% CI: 1.10-14.47) were associated with mortality. CONCLUSIONS: TTVR is associated with an acute decline in RV systolic function. Although common, early postprocedural RV dysfunction was not associated with midterm mortality.
Source: EuroIntervention
Authors: Cristian Herrera-Flores, Sebastian Rosch, Charlotte Wolff, Felix Passoke, Anne Schöber, Sara Bombace, Javier Herrera-Flores, Florian Schlotter, Tobias Ruf, Ralph Stephan von Bardeleben, Karl-Philipp Rommel, Holger Thiele, Tobias Kister, Tilman Emrich, Philipp Lurz, Ignacio Cruz-Gonzalez, Karl-Patrik Kresoja
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225653943