Frequency and Outcomes of Acute Hemodynamic Instability Following Transcatheter Tricuspid Valve Replacement: Insights From the CESAR-TR-Registry.

Background Transcatheter tricuspid valve replacement (TTVR) eliminates tricuspid regurgitation, leading to acute hemodynamic changes. It is unclear whether this might lead to acute hemodynamic instability (AHI).Objectives The aim of this study was to report the frequency, outcomes, and risk factors of AHI following TTVR.Methods Patients undergoing TTVR at 5 international centers were included. AHI after TTVR was defined as class ≥ C shock according to the Society for Cardiovascular Angiography and Interventions classification.Results The study included 200 patients with a mean age of 78 ± 11 years (64% women). The frequency of AHI was 8.5%, and in all patients the onset was within 24 hours after the procedure. Compared with patients without postprocedural AHI, intrahospital mortality was significantly higher in AHI patients (35.2% vs 0.1%; P < 0.001). Univariate regression identified low glomerular filtration rate, reduced left ventricular ejection fraction, decreased ratio of tricuspid annular plane systolic excursion to mean pulmonary artery pressure, and elevated pulmonary capillary wedge pressure as significant factors of AHI.Conclusions AHI is a life-threatening complication in the early postprocedural period following TTVR. Elevated left-sided filling pressures, pulmonary hypertension, and impaired renal function are associated with an increased risk for AHI, suggesting that patient selection and preprocedural optimization are critical.