Transcatheter Treatment with EVOQUE: First Real-World Results

Severe tricuspid regurgitation (TR) has historically been underestimated due to its poor prognosis and the limited benefit associated with available therapeutic interventions, which are characterized by high periprocedural morbidity and mortality. In recent years, the development of transcatheter therapies has redefined the therapeutic approach, offering viable alternatives for patients who are not candidates for surgery, either through transcatheter edge-to-edge repair (TEER) or transcatheter tricuspid valve replacement (TTVR).

The study presented by Angellotti et al. is the first multicenter analysis of the use of the EVOQUE system in a real-world setting following its approval in Europe and the encouraging results of the TRISCEND II study.

Researchers included a total of 176 consecutive patients with severe or greater TR, treated at 12 high-volume European centers. The mean age was 77.8 years, with a high proportion of women (72%) and a high-risk clinical profile (TRI-SCORE ≥6 in 51% of patients). Common comorbidities included atrial fibrillation (88.6%), chronic kidney disease (69.3%), and moderate/severe right ventricular dysfunction (20.5%).

The procedure was successful in 97.2% of cases, achieving a significant TR reduction to none or mild in 98.4% of patients.

The clinical success rate according to TVARC criteria was 86.9% at 30 days (considering proper and effective device positioning and absence of mortality, stroke, or reintervention). A significant functional improvement was reported: 79.7% of patients were in NYHA functional class I/II at one month, compared to 20.2% at baseline (p <0.001). Additionally, there were improvements in hepatorenal function parameters, as well as reductions in peripheral edema and body weight.

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Nevertheless, it is important to consider the clinical complexity of this population: in-hospital mortality was 3.4%, and 14.2% of patients required a permanent pacemaker, which was significantly associated with pre-existing conduction disorders (odds ratio [OR] 4.53; p=0.002).

In patients with moderate/severe right ventricular dysfunction, TTVR was associated with a higher rate of clinical failure (OR 3.60; p=0.008), reflecting the vulnerability of this population to increased afterload once the regurgitation was resolved.

Conclusions

This real-world analysis provides relevant evidence on the use of the EVOQUE system for TTVR, highlighting the importance of preprocedural assessment of right ventricular function and the conduction system as key predictors of adverse events.

Original Title: Early Outcomes of Real-World Transcatheter Tricuspid Valve Replacement.

Reference: Angellotti D, Mattig I, Samim D, Goebel B, Jantsch C, Rubinic B, Ruf T, Geisler T, Kessler M, Adam M, Stolz L, Dannenberg V, Kassar M, Stathogiannis K, Cesario V, Dumonteil N, Chrissoheris M, Spargias K, Baldus S, Rottbauer W, Gerçek M, Bartko PM, Lapp H, Dreger H, Hausleiter J, Lurz P, Windecker S, Rudolph V, Praz F. Early Outcomes of Real-World Transcatheter Tricuspid Valve Replacement. JACC Cardiovasc Interv. 2025 Jun 21:S1936-8798(25)01617-6. doi: 10.1016/j.jcin.2025.06.002. Epub ahead of print. PMID: 40560107.