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The Right Heart's New Reality: A Longitudinal Assessment After Transcatheter Tricuspid Valve Replacement with EVOQUE
Session:
Sessão de Posters 41 - Intervenções estruturais cardíacas e resultados
Speaker:
Tatiana Pereira Dos Santos
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Tatiana Pereira dos Santos; Ana L. Silva; Gonçalo Ferraz Costa; Ana Botelho; José Luís Martins; Manuel Santos; Luís Paiva; Elisabete Jorge; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Background: Severe tricuspid regurgitation (TR) can now be treated with Transcatheter Tricuspid Valve Replacement (TTVR) using the EVOQUE system. Right ventricular (RV) dysfunction predicts adverse outcomes, but the long-term effects of TTVR on RV performance is unclear.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods: Single-center prospective analysis of patients who underwent TTVR between October 2024-October 2025. RV function was assessed by echocardiography using tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and both global and free-wall right ventricular longitudinal strain before and after TTVR. Median imaging follow-up (FUP) was 2 months (IQR 1–5). Secondary endpoints were heart-failure hospitalization and all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results: The cohort included 18 patients (55.6% female; median age 79.5(IQR 10) years). Hypertension was present in 88.9%, diabetes in 16.7%, atrial fibrillation in 94.5%, and chronic kidney disease in 50%. Most patients (55.6%) had torrential TR, whereas 27.8% had severe and 16.7% massive TR. Median NT-proBNP was 1801.5pg/mL (IQR 3084.8). Seventeen patients underwent baseline right-heart catheterization, 70.6%(12/17) had pulmonary hypertension. Hemodynamic values included mean pulmonary artery pressure 23.8±1.8mmHg, right atrial pressure 10.8±1.2mmHg, pulmonary vascular resistance 2.5±0.4WU, and cardiac index 2.1 (IQR 0.76)L/min/m². FUP echocardiography was performed in 16 patients and showed significant declines across all RV parameters: TAPSE (17.5±1.3vs.10.1±1.2mm), FAC (39.8±2.1%vs.28.1±2.8%), RV global strain (–19.3±1.1%vs.–11.9±1.4%), and RV free-wall strain (–22.4±1.4%vs.–11.8±1.2%) (p < 0.001). TR in FUP was as follows: 22.1% no/trace, 55.6% mild, and 11.1% moderate. All-cause mortality was 11.1%(2 patients) with 2 heart-failure hospitalizations. No associations were found between invasive or pre-TTVR echocardiographic parameters and adverse events, which may be related to the limited sample size.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusion: TTVR was associated with a short-term decline in RV functional indices, likely from acute afterload mismatch after TR elimination. This early change appears to reflect RV remodeling rather than irreversible dysfunction. Because prosthesis-related restriction limits TAPSE reliability, RV strain and 3D volumetric imaging (using cardiac magnetic resonance) may better assess post-TTVR RV performance. Larger, long-term studies may clarify RV remodeling trajectories and identify patients most likely to benefit clinically.</span></span></p>
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