Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads: The TRIPLACE Registry

Bryan P Traynor; Andrea Scotti; Rishi Puri; Matteo Sturla; Firas Zahr; Robert Boone; Susheel Kodali; Didier Tchétché; Ole De Backer; Augustin Coisne; Sebastian Ludwig; Lukas Stolz; Rodrigo Estévez Loureiro; Matti Adam; Federico De Marco; Matteo Biroli; Edwin C Ho; Anson Cheung; Alexandru Patrascu; Sami Alnasser; Scott Chadderdon; Davorka Lulic; Joanna Bartkowiak; Julio Echarte-Morales; Horst Sievert; Timothy Byrne; Francesco Maisano; Christian Frerker; Nicolas Dumonteil; Omar A Oliva; Tanja K Rudolph; Felix Rudolph; Amar Krishnaswamy; Samir R Kapadia; Juan Del Portillo; Josep Rodés-Cabau; Niklas Schofer; Juan F Granada; Jörg Hausleiter; Rebecca T Hahn; Thomas Modine; Azeem Latib; Neil Fam

doi:10.1016/j.jacep.2025.12.027

Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads: The TRIPLACE Registry

Bryan P Traynor, Andrea Scotti, Rishi Puri, Matteo Sturla, Firas Zahr, Robert Boone, Susheel Kodali, Didier Tchétché, Ole De Backer, Augustin Coisne, Sebastian Ludwig, Lukas Stolz, Rodrigo Estévez Loureiro, Matti Adam, Federico De Marco, Matteo Biroli, Edwin C Ho, Anson Cheung, Alexandru Patrascu, Sami AlnasserScott Chadderdon, Davorka Lulic, Joanna Bartkowiak, Julio Echarte-Morales, Horst Sievert, Timothy Byrne, Francesco Maisano, Christian Frerker, Nicolas Dumonteil, Omar A Oliva, Tanja K Rudolph, Felix Rudolph, Amar Krishnaswamy, Samir R Kapadia, Juan Del Portillo, Josep Rodés-Cabau, Niklas Schofer, Juan F Granada, Jörg Hausleiter, Rebecca T Hahn, Thomas Modine, Azeem Latib, Neil Fam

Afdeling for Hjertesygdomme HJE

Abstract

BACKGROUND: Patients undergoing orthotopic transcatheter tricuspid valve replacement (TTVR) frequently present with a cardiac implantable electronic device (CIED) lead traversing the tricuspid valve.

OBJECTIVES: This study sought to investigate the clinical, procedural, and lead-related outcomes of orthotopic TTVR in patients with transvalvular CIED leads.

METHODS: All consecutive patients enrolled in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry (NCT06033274) were included for analysis. Patients were stratified based on the presence of a CIED lead traversing the tricuspid valve. Changes in lead function parameters were assessed after TTVR in a subset of these patients who had pacemaker lead parameter data recorded. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion.

RESULTS: Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual tricuspid regurgitation (82.6% vs 91.4%; P < 0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs 7.1%; P < 0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. No significant increase in adverse events or mortality was observed at 30 days.

CONCLUSIONS: Orthotopic TTVR in patients with transvalvular CIED leads can be safely and effectively performed with low rates of lead failure. Significant paravalvular leak and residual tricuspid regurgitation is more common with a jailed lead. These patients require close CIED follow-up with alternative pacing strategies in place, particularly when pacing dependent. (Global Multicenter Registry on Transcatheter TRIcuspid Valve RePLACEment [TRIPLACE]; NCT06033274).

Originalsprog	Engelsk
Tidsskrift	JACC. Clinical electrophysiology
ISSN	2405-5018
DOI	https://doi.org/10.1016/j.jacep.2025.12.027
Status	E-pub ahead of print - 20 jan. 2026

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10.1016/j.jacep.2025.12.027

Citationsformater

Traynor, B. P., Scotti, A., Puri, R., Sturla, M., Zahr, F., Boone, R., Kodali, S., Tchétché, D., De Backer, O., Coisne, A., Ludwig, S., Stolz, L., Loureiro, R. E., Adam, M., De Marco, F., Biroli, M., Ho, E. C., Cheung, A., Patrascu, A., ... Fam, N. (2026). Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads: The TRIPLACE Registry. JACC. Clinical electrophysiology. Advance online publication. https://doi.org/10.1016/j.jacep.2025.12.027

Traynor, BP, Scotti, A, Puri, R, Sturla, M, Zahr, F, Boone, R, Kodali, S, Tchétché, D, De Backer, O, Coisne, A, Ludwig, S, Stolz, L, Loureiro, RE, Adam, M, De Marco, F, Biroli, M, Ho, EC, Cheung, A, Patrascu, A, Alnasser, S, Chadderdon, S, Lulic, D, Bartkowiak, J, Echarte-Morales, J, Sievert, H, Byrne, T, Maisano, F, Frerker, C, Dumonteil, N, Oliva, OA, Rudolph, TK, Rudolph, F, Krishnaswamy, A, Kapadia, SR, Portillo, JD, Rodés-Cabau, J, Schofer, N, Granada, JF, Hausleiter, J, Hahn, RT, Modine, T, Latib, A & Fam, N 2026, 'Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads: The TRIPLACE Registry', JACC. Clinical electrophysiology. https://doi.org/10.1016/j.jacep.2025.12.027

@article{2f4496c65c564aff94beba6b57a9bdda,

title = "Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads: The TRIPLACE Registry",

abstract = "BACKGROUND: Patients undergoing orthotopic transcatheter tricuspid valve replacement (TTVR) frequently present with a cardiac implantable electronic device (CIED) lead traversing the tricuspid valve.OBJECTIVES: This study sought to investigate the clinical, procedural, and lead-related outcomes of orthotopic TTVR in patients with transvalvular CIED leads.METHODS: All consecutive patients enrolled in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry (NCT06033274) were included for analysis. Patients were stratified based on the presence of a CIED lead traversing the tricuspid valve. Changes in lead function parameters were assessed after TTVR in a subset of these patients who had pacemaker lead parameter data recorded. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion.RESULTS: Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual tricuspid regurgitation (82.6% vs 91.4%; P < 0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs 7.1%; P < 0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. No significant increase in adverse events or mortality was observed at 30 days.CONCLUSIONS: Orthotopic TTVR in patients with transvalvular CIED leads can be safely and effectively performed with low rates of lead failure. Significant paravalvular leak and residual tricuspid regurgitation is more common with a jailed lead. These patients require close CIED follow-up with alternative pacing strategies in place, particularly when pacing dependent. (Global Multicenter Registry on Transcatheter TRIcuspid Valve RePLACEment [TRIPLACE]; NCT06033274).",

author = "Traynor, {Bryan P} and Andrea Scotti and Rishi Puri and Matteo Sturla and Firas Zahr and Robert Boone and Susheel Kodali and Didier Tch{\'e}tch{\'e} and {De Backer}, Ole and Augustin Coisne and Sebastian Ludwig and Lukas Stolz and Loureiro, {Rodrigo Est{\'e}vez} and Matti Adam and {De Marco}, Federico and Matteo Biroli and Ho, {Edwin C} and Anson Cheung and Alexandru Patrascu and Sami Alnasser and Scott Chadderdon and Davorka Lulic and Joanna Bartkowiak and Julio Echarte-Morales and Horst Sievert and Timothy Byrne and Francesco Maisano and Christian Frerker and Nicolas Dumonteil and Oliva, {Omar A} and Rudolph, {Tanja K} and Felix Rudolph and Amar Krishnaswamy and Kapadia, {Samir R} and Portillo, {Juan Del} and Josep Rod{\'e}s-Cabau and Niklas Schofer and Granada, {Juan F} and J{\"o}rg Hausleiter and Hahn, {Rebecca T} and Thomas Modine and Azeem Latib and Neil Fam",

year = "2026",

month = jan,

day = "20",

doi = "10.1016/j.jacep.2025.12.027",

language = "English",

journal = "JACC. Clinical electrophysiology",

issn = "2405-5018",

publisher = "Elsevier USA",

}

TY - JOUR

T1 - Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads

T2 - The TRIPLACE Registry

AU - Traynor, Bryan P

AU - Scotti, Andrea

AU - Puri, Rishi

AU - Sturla, Matteo

AU - Zahr, Firas

AU - Boone, Robert

AU - Kodali, Susheel

AU - Tchétché, Didier

AU - De Backer, Ole

AU - Coisne, Augustin

AU - Ludwig, Sebastian

AU - Stolz, Lukas

AU - Loureiro, Rodrigo Estévez

AU - Adam, Matti

AU - De Marco, Federico

AU - Biroli, Matteo

AU - Ho, Edwin C

AU - Cheung, Anson

AU - Patrascu, Alexandru

AU - Alnasser, Sami

AU - Chadderdon, Scott

AU - Lulic, Davorka

AU - Bartkowiak, Joanna

AU - Echarte-Morales, Julio

AU - Sievert, Horst

AU - Byrne, Timothy

AU - Maisano, Francesco

AU - Frerker, Christian

AU - Dumonteil, Nicolas

AU - Oliva, Omar A

AU - Rudolph, Tanja K

AU - Rudolph, Felix

AU - Krishnaswamy, Amar

AU - Kapadia, Samir R

AU - Portillo, Juan Del

AU - Rodés-Cabau, Josep

AU - Schofer, Niklas

AU - Granada, Juan F

AU - Hausleiter, Jörg

AU - Hahn, Rebecca T

AU - Modine, Thomas

AU - Latib, Azeem

AU - Fam, Neil

PY - 2026/1/20

Y1 - 2026/1/20

N2 - BACKGROUND: Patients undergoing orthotopic transcatheter tricuspid valve replacement (TTVR) frequently present with a cardiac implantable electronic device (CIED) lead traversing the tricuspid valve.OBJECTIVES: This study sought to investigate the clinical, procedural, and lead-related outcomes of orthotopic TTVR in patients with transvalvular CIED leads.METHODS: All consecutive patients enrolled in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry (NCT06033274) were included for analysis. Patients were stratified based on the presence of a CIED lead traversing the tricuspid valve. Changes in lead function parameters were assessed after TTVR in a subset of these patients who had pacemaker lead parameter data recorded. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion.RESULTS: Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual tricuspid regurgitation (82.6% vs 91.4%; P < 0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs 7.1%; P < 0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. No significant increase in adverse events or mortality was observed at 30 days.CONCLUSIONS: Orthotopic TTVR in patients with transvalvular CIED leads can be safely and effectively performed with low rates of lead failure. Significant paravalvular leak and residual tricuspid regurgitation is more common with a jailed lead. These patients require close CIED follow-up with alternative pacing strategies in place, particularly when pacing dependent. (Global Multicenter Registry on Transcatheter TRIcuspid Valve RePLACEment [TRIPLACE]; NCT06033274).

AB - BACKGROUND: Patients undergoing orthotopic transcatheter tricuspid valve replacement (TTVR) frequently present with a cardiac implantable electronic device (CIED) lead traversing the tricuspid valve.OBJECTIVES: This study sought to investigate the clinical, procedural, and lead-related outcomes of orthotopic TTVR in patients with transvalvular CIED leads.METHODS: All consecutive patients enrolled in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry (NCT06033274) were included for analysis. Patients were stratified based on the presence of a CIED lead traversing the tricuspid valve. Changes in lead function parameters were assessed after TTVR in a subset of these patients who had pacemaker lead parameter data recorded. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion.RESULTS: Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual tricuspid regurgitation (82.6% vs 91.4%; P < 0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs 7.1%; P < 0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. No significant increase in adverse events or mortality was observed at 30 days.CONCLUSIONS: Orthotopic TTVR in patients with transvalvular CIED leads can be safely and effectively performed with low rates of lead failure. Significant paravalvular leak and residual tricuspid regurgitation is more common with a jailed lead. These patients require close CIED follow-up with alternative pacing strategies in place, particularly when pacing dependent. (Global Multicenter Registry on Transcatheter TRIcuspid Valve RePLACEment [TRIPLACE]; NCT06033274).

U2 - 10.1016/j.jacep.2025.12.027

DO - 10.1016/j.jacep.2025.12.027

M3 - Journal article

C2 - 41575411

SN - 2405-5018

JO - JACC. Clinical electrophysiology

JF - JACC. Clinical electrophysiology

ER -

Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Device Leads: The TRIPLACE Registry

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