Transjugular Transcatheter Tricuspid Valve Replacement With the Evoque System

Transcatheter tricuspid valve replacement (TTVR) with the Evoque tricuspid valve replacement system using a transfemoral (TF) approach has demonstrated safety and efficacy in patients with severe symptomatic tricuspid regurgitation. However, anatomical constraints may preclude TF delivery, necessitating alternative approaches. We present a step-by-step guide for performing TTVR via the transjugular (TJ) route based on 2 successful cases. In the first case, TJ access was selected upfront owing to the presence of an Adams-DeWeese inferior vena cava clip, which created a mechanical obstruction to femoral access. In the second case, TF access was attempted but abandoned owing to unfavorable trajectory, making valve deployment unsuccessful despite attempts from both the right and left femoral veins. This guide provides detailed procedural steps, technical considerations, and an algorithm for patient selection to help operators successfully perform TJ TTVR when TF access is not suitable.