Transcatheter Tricuspid Valve Replacement With Intracardiac Imaging as the Sole Imaging Modality: Procedural and Clinical Outcomes

Background Transcatheter tricuspid valve replacement (TTVR) results in quality of life improvement in patients with severe tricuspid regurgitation. To date, this procedure has been performed primarily with transesophageal echocardiography (TEE) guidance, with the use of intracardiac echocardiography (ICE) as an adjunctive imaging modality. In this study, we describe the outcomes of patients undergoing TTVR using ICE as the sole imaging modality compared with those undergoing TEE-guided TTVR with or without adjunctive ICE imaging. Methods Retrospective analysis of consecutive patients undergoing TTVR using the EVOQUE valve (Edwards Lifesciences) was included. Baseline characteristics, procedural characteristics, and 30-day clinical outcomes were compared. Results Of the 58 patients undergoing TTVR, an ICE-only strategy was employed in 10 (17.2%), of which half were performed with conscious sedation only. Thirty patients (62.5%) in the standard imaging group used ICE in addition to TEE guidance. Procedural time was shorter in the ICE-only group (86.7 minutes vs 110.5 minutes; P = .02), and fluoroscopy time was lower (21.8 minutes vs 33.5 minutes; P = .01). Thirty-day clinical outcomes were similar in both groups. Conclusions ICE is a feasible sole procedural imaging modality for TTVR, possible with conscious sedation alone, and associated with lower procedural/fluoroscopy times and comparable clinical outcomes.