From the Research
Transcatheter tricuspid valve replacement (TTVR) with the EVOQUE system is indicated for patients with symptomatic, severe tricuspid regurgitation (TR) who are at high surgical risk or deemed inoperable, as demonstrated by the most recent study in 2022 1.
Indications for TTVR with EVOQUE
The following are key considerations for TTVR with EVOQUE:
- Patients should have New York Heart Association (NYHA) class II-IV heart failure symptoms despite optimal medical therapy, which includes diuretics and guideline-directed medical therapy for any underlying heart failure.
- Anatomical considerations for EVOQUE eligibility include suitable tricuspid annular dimensions (typically 36-52mm), adequate right ventricular function, and appropriate landing zones for the valve.
- Patients should have a life expectancy exceeding one year to justify the procedure.
- Contraindications include active endocarditis, severe right ventricular dysfunction, significant pulmonary hypertension (mean pulmonary artery pressure >60mmHg), or anatomical features incompatible with the device.
Rationale
The EVOQUE system addresses TR by replacing the native valve with a bioprosthesis, reducing volume overload on the right heart and improving symptoms, as shown in a study published in 2021 2. This intervention is particularly valuable for patients with TR who cannot tolerate open-heart surgery due to comorbidities or previous cardiac surgeries, offering them a minimally invasive alternative with shorter recovery times. A systematic review and meta-analysis published in 2022 3 also supports the efficacy and safety of transcatheter tricuspid valve replacement for significant tricuspid valve regurgitation.
Key Benefits
The benefits of TTVR with EVOQUE include:
- Reduction of TR to mild or less in a significant proportion of patients, as demonstrated in the TRISCEND study 1.
- Improvement in NYHA functional class, 6-minute walk distance, and quality-of-life measures.
- Acceptable safety profile, with low rates of major adverse events and no device-related pulmonary embolism.