Transcatheter Tricuspid Valve Replacement in a Heart Transplant Recipient

Background: Transcatheter tricuspid valve replacement (TTVR) is an emerging therapy for patients with severe tricuspid regurgitation (TR) who are often at prohibitive surgical risk. Orthotopic heart transplant recipients represent a particularly high-risk subgroup, frequently excluded from surgical intervention and underrepresented in clinical trials. Case Summary: We present one of the inaugural cases of TTVR using the EVOQUE valve system (Edwards Lifesciences) in an orthotopic heart transplant recipient with severe TR. The procedure was completed successfully without complications, yielding a well-seated prosthetic valve with no significant paravalvular leak and marked reduction in TR. The patient demonstrated significant clinical improvement, with functional status improving to NYHA functional class II. Discussion: This case illustrates the feasibility and safety of the EVOQUE TTVR system in complex, high-risk patients. Importantly, it highlights the potential of this therapy in heart transplant recipients with torrential TR, a challenging population with limited therapeutic options. Take-Home Messages: The EVOQUE TTVR system appears to be a safe and feasible treatment option for orthotopic heart transplant recipients with severe or torrential TR, even in the setting of prior failed transcatheter edge-to-edge repair and challenging right heart anatomy. Multimodality imaging (transesophageal echocardiography, intracardiac echocardiography, and computed tomography) plays a critical role in procedural planning and guidance for complex TTVR cases, helping optimize outcomes in high-risk patients.