Transjugular transcatheter tricuspid valve replacement (TTVR) can be performed safely and effectively in patients with cardiac implantable electronic devices (CIEDs), such as pacemakers and defibrillators, a new study suggests. Findings from the research analyzed outcomes from 99 patients of which 36 patients had CIEDs. Procedural success rates were high in both groups, with no significant differences in 30-day survival or symptom improvement. “Transjugular TTVR is safe and effective for managing tricuspid regurgitation (TR) and heart failure in patients with CIEDs. Due to the small sample size, these findings highlight the need for larger, prospective studies to validate these outcomes,” wrote the paper’s authors, led by Kent Chak-Yu So, MD, from the Chinese University of Hong Kong. TR reduction The research team found that 83.8% of patients with CIEDs achieved significant TR reduction at 30 days, similar to the 84.9% observed in patients without CIEDs. Symptom improvement was also comparable, with around 80% of both groups reporting relief from heart failure symptoms. Further findings revealed that while the CIED group showed slightly higher rates of conversion to surgery (8.3% vs 1.6%) and reintervention within six months (11.5% vs 3.3%), these differences did not reach statistical significance. The study, which is due to appear in JACC: Asia, also noted a higher incidence of paravalvular leak (PVL) among CIED patients, with most cases classified as mild and clinically insignificant. However, severe PVL, though relatively rare, was associated with poorer symptom improvement during follow-up. Good outcomes “In our experience, it was observed that in some patients, the paravalvular leak progressed within 1 month,” noted the paper’s authors. “One CIED case had a septal anchor detachment and another had valve tilting, but the majority of patients maintained good outcomes.” Significantly, suggestions that the valve procedure might damage pacing leads were not observed in the short-term results. No patients required lead replacement or extraction during a median follow-up of 3.3 months, though 9.1% experienced changes in device parameters that were managed with reprogramming. Retrospective study “This illustrates the possibility of delayed lead dysfunction and highlights the importance of close monitoring of lead parameters following TTVR,” wrote the paper’s authors. While the data are encouraging, the authors cautioned that the study was retrospective, with patients treated under compassionate use protocols. As such, results may not generalize to earlier stages of TR. Nevertheless, the findings provide new evidence that patients with pacemakers or defibrillators, traditionally considered complex candidates, may benefit from TTVR. Source: So KC, Stolz L, Fam N, et al. Transjugular Transcatheter Tricuspid Valve Replacement in Patients With Cardiac Implantable Electronic Devices. JACC Asia. 2025 September 8 (Article in Press). Image Credit: blueringmedia – stock.adobe.com