Computed tomography for transcatheter tricuspid valve development

Background Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to be optimized. We sought to assess the challenges of TTVR and the determinants of venous route using computed tomography (CT) analysis. Methods and results A total of 195 end-diastolic cardiac CT performed prior to surgical correction of a severe TR ( n = 38), transcatheter aortic valve replacement ( n = 89), or left atrial appendage closure ( n = 68) were analyzed. Patients with TR ( n = 68; 19 primary and 49 secondary) were compared with patients without ( n = 127). Continuous variables with normal and non-normal distributions were compared using Student t test or Mann–Whitney test respectively. The angle from the tricuspid annulus (TA) to the inferior vena cava was tighter (mean = 101 ± 18°) with a broader range of value (44° to 164°) than to the superior vena cava (mean = 143 ± 9°). Patients with TR had rounder TA (eccentricity index of 0.88 ± 0.08, p