Impact of transcatheter tricuspid valve replacement on regional right ventricular contraction patterns

Abstracts Background Orthotopic transcatheter tricuspid valve replacement (TTVR) provides effective reduction of tricuspid regurgitation (TR). However, the impact of the radial force-dependent anchoring mechanism (e.g. EVOQUE) on basal right ventricular (RV) contraction remains unknown. Aims We aimed to investigate changes in RV contraction patterns following EVOQUE compared with transcatheter edge-to-edge repair (T-TEER) to observe differences in segmental contraction and possible implications for right ventricular reverse remodeling. Methods and results We retrospectively analyzed 393 patients with severe TR undergoing tricuspid transcatheter intervention (EVOQUE, n=43; T-TEER, n=350). 3D-echocardiography was performed at baseline and serial follow-up to 2 years. RV contraction patterns were quantified using the ReVISION software, which allows analysis of 15 RV segments. Changes over the course of follow-up were assessed using paired analyses and linear mixed-effects models adjusted for covariates. At baseline, regional RV contraction patterns were comparable between treatment groups. Both interventions were associated with an immediate reduction in global RV function after the procedure. During follow-up, however, patients undergoing TTVR demonstrated persistent impairment of the right ventricular inflow segment, whereas all RV segments recovered following T-TEER. After multivariable adjustment, inflow segment contraction remained significantly lower after EVOQUE compared with T-TEER up to 2 years. Despite persistent regional impairment, global RV function recovered substantially after TTVR. Conclusion EVOQUE is associated with sustained impairment of contraction of the right ventricular inflow segment while preserving substantial long-term recovery of global RV function. These findings suggest that radial force-dependent valve anchoring alters regional RV mechanics without preventing overall right ventricular reverse remodeling.