The impact of transcatheter tricuspid valve replacement on right ventricular function

Abstract Background Transcatheter tricuspid valve replacement (TTVR) is increasingly used as a therapy option for patients with severe tricuspid regurgitation (TR) who are ineliglibe for heart surgery.[1] Previous studies revealed that impaired right ventricular dysfunction was an independent negative predictor of the clinical success.[2] However, the impact of the TTVR on the right ventricular function remains unknown. Purpose The aim of this study was to analyze the acute and chronic changes in the right ventricular function after the TTVR. Methods All patients undergoing TTVR using Evoque and LuxValve in a single tertiary center in Germany between 12/2023 and 07/2025 were included. The echocardiographic assessment was performed before TTVR, at discharge and by follow-up after 30-days. Right ventricular function was evaluated using tricuspid annular plane systolic excursion (TAPSE), right ventricular free wall strain (RV FWS), fractional area change (RV FAC) and peak systolic velocity of the right ventricle's tricuspid annulus with tissue Doppler imaging (RV S’). The statistical analysis was conducted using paired t-test. Results The study included 29 patients, with a median age of 74.8±7.3 years and 65.5% of them were women. Patients presented with severe (10.3%), massive (37.9%), and torrential (51.7%) TR at baseline. Right ventricular function was mildly impaired prior to TTVR (Table 1.). Our analysis revealed that TAPSE, FAC and RV FWS were significantly reduced directly after TTVR, whereas there was no significant change in RV S’. TAPSE reduction persisted at 30 days follow-up and RV S´ significantly decreased at 30-day follow-up. On the contrary, improvements were observed in the RV FWS and FAC after 30 days. Conclusion Right ventricular function is acutely reduced after TTVR. TAPSE and RV S’ remain persistently reduced after 30-days, however RV FWS and FAC revealed slight improvements during follow-up. How the observed changes in right ventricular function following TTVR impact clinical outcome and prognosis requires further study.For image description, please refer to the figure legend and surrounding text.