Transcatheter tricuspid valve replacement in arrhythmogenic right ventricular cardiomyopathy after prior cardioband annuloplasty: insights from the first-in-man case report

Severe tricuspid regurgitation (TR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) represents a particularly challenging clinical scenario due to advanced right ventricular dysfunction, complex device interactions, and high procedural risk. Evidence regarding transcatheter tricuspid valve replacement (TTVR) in ARVC, especially following prior transcatheter annuloplasty procedures such as Cardioband, remains scarce.

We present the first in-man case report of a successful transfemoral TTVR using the EVOQUE™ system in a 69-year-old patient with ARVC, severe TR, heart failure symptoms corresponding to New York Heart Association (NYHA) class IV, prior Cardioband annuloplasty, and an implantable cardioverter-defibrillator (ICD). The patient presented with advanced right heart failure requiring intensive pre-procedural stabilization. TTVR with a 56-mm EVOQUE™ valve resulted in an immediate reduction of TR from grade V to grade 0. The post-procedural course was complicated by severe right heart failure, respiratory insufficiency requiring prolonged mechanical ventilation, ventricular arrhythmias associated with subtherapeutic amiodarone levels, and acute kidney injury requiring temporary renal replacement therapy. Following multidisciplinary intensive care management, the patient stabilized with marked clinical improvement and sustained valve function.

This case highlights the feasibility of EVOQUE™ TTVR in patients with prior annuloplasty devices and advanced ARVC. It demonstrates the substantial risk of post-procedural right heart failure and complex device interactions, emphasizing that procedural success does not preclude a complicated clinical course. Careful patient selection, procedural planning, and intensive post-procedural management are essential in this high-risk population.