TRIPLACE Registry: Conduction Disorders Following Transcatheter Tricuspid Valve Replacement

Tricuspid regurgitation (TR) has become increasingly common and has been associated to hospitalization for cardiac failure and increased mortality. 

The current guidelines continue to recommend surgical replacement, despite its 8 to 12% mortality, according to different series. 

Transcatheter tricuspid valve replacement (TTVR) is being looked at and different randomized trials have shown promising results. However, several questions remain unanswered, among them, post procedural conduction disorders. 

This analysis of the TRIPLACE registry (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement), included 185 inoperable severe TR patients with no prior definite pacemaker treated with TTVR.

The primary outcome was high grade atrioventricular (AV) block at 30 days. 

Mean patient age was 76, and they were mostly women. Mean TRISCORE was 14. Close to 90% were in functional class II-III, and over 40% had been hospitalized within12 months prior procedure. Also, 68% had hypertension, 27% diabetes, 49% kidney function deterioration, 14% COPD, 11% peripheral vascular disease, 77% peripheral edema, 24% ascites, 5% a history of TAVR, 5% CABG and 5% tricuspid surgery. 

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The most frequent TR etiology was secondary (84%), followed by primary and in lower proportion mixed. Most predominant TR degree was torrential (44%), followed by severe (33%) and massive in the remaining cases.

At baseline EKG, 88% presented atrial fibrillation, 6% first degree AV block, 23% complete right bundle branch block (RBBB), 10% incomplete RBBB, 3% complete left BBB, 7% anterior or posterior fascicular block, and 2.7% bifascicular block.

As regards devices, the EVOQUE was used in 75 patients, the LUX PLUS in 53, CARDIOVALVE in 29 and others in 28.

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The primary outcome was seen in 13.5% (25 patients). Most high grade AV blocks were seen during the first week after procedure (88%). The need for pacemaker implantation was 11.9% (45% leadless, 27.3% coronary sinus leads, and the rest with other techniques. Malapposition was observed in 5 patients, and there was no embolization, migration or mortality. 

Complete or fascicular LBBB (anterior or posterior) at baseline was associated with higher risk of high grade AV block. 

Conclusion

High grade AV block was observed in 13.5% of patients undergoing transcatheter tricuspid valve replacement, mostly during the first week after procedure. The presence of complete / fascicular LBBB at baseline was significantly associated to high grade AV block after TTVR. 

Original Title: Incidence, Predictors, and Management of Conduction Disturbances After Transcatheter Tricuspid Valve Replacement. The TRIPLACE Registry.

Reference: Andrea Scotti,et al. JACC Cardiovasc Interv. 2025;18:1789–1799.