Contrast-Sparing Intravascular Ultrasound–Guided Caval Valve Implantation for Severe Symptomatic Tricuspid Regurgitation

Patients with severe tricuspid regurgitation and right ventricular dysfunction have limited therapeutic options due to anatomic complexity, advanced disease at presentation, and comorbidities. Caval valve implantation is an emerging transcatheter therapy. We present a case series of contrast-sparing caval valve implantation using intravascular ultrasound guidance in patients with renal failure. (Level of Difficulty: Advanced.

Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access

Background Peripheral vascular intervention (PVI) is occasionally required to facilitate delivery system insertion or to treat vascular complications during transfemoral transcatheter aortic valve replacement (TF‐TAVR). However, the impact of PVI on outcomes is not well understood. Therefore, we aimed to compare outcomes between TF‐TAVR with versus without PVI and between TF‐TAVR with PVI versus non‐TF‐TAVR. Methods and Results We retrospectively reviewed 2386 patients who underwent TAVR with a balloon‐expandable valve at a single institution from 2016 to 2020. The primary outcomes were death and major adverse cardiac/cerebrovascular event (MACCE), defined as death, myocardial infarction, or stroke. Of 2246 TF‐TAVR recipients, 136 (6.1%) required PVI (89% bailout treatment). During follow‐up (median 23.0 months), there were no significant differences between TF‐TAVR with and without PVI in death (15.4% versus 20.7%; adjusted HR [aHR], 0.96 [95% CI, 0.58–1.58]) or MACCE (16.9% versus 23.0%; aHR, 0.84 [95% CI, 0.52–1.36]). However, compared with non‐TF‐TAVR (n=140), TF‐TAVR with PVI carried significantly lower rates of death (15.4% versus 40.7%; aHR, 0.42 [95% CI, 0.24–0.75]) and MACCE (16.9% versus 45.0%; aHR, 0.40 [95% CI, 0.23–0.68]). Landmark analyses demonstrated lower outcome rates following TF‐TAVR with PVI than non‐TF‐TAVR both within 60 days (death 0.7% versus 5.7%, P=0.019; MACCE 0.7% versus 9.3%; P=0.001) and thereafter (death 15.0% versus 38.9%, P=0.014; MACCE 16.5% versus 41.3%, P=0.013). Conclusions The need for PVI during TF‐TAVR is not uncommon, mainly due to the bailout treatment for vascular complications. PVI is not associated with worse outcomes in TF‐TAVR recipients. Even when PVI is required, TF‐TAVR is associated with better short‐ and intermediate‐term outcomes than non‐TF‐TAVR