Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left panel: The overall working length of the EVOQUE delivery device is 78 mm from the inflexion point to the capsule and 90 mm from the inflexion point to the tip of the nose cone. Right panel: The minimum working length to accommodate the EVOQUE delivery device is an RA >50 mm and an overall working length of RA and RV >100 cm. However, other factors affect the capsule position from the TV annulus, including the IVC–TVA offset and the EV distance from the TVA. Abbreviations: EV, Eustachian valve; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; TV, tricuspid valve; TVA, tricuspid valve annulus.

Article Snippet: The EVOQUE transcatheter tricuspid valve (TV) replacement (TTVR) system (Edwards Lifesciences, Irvine, California) is the first and only Food and Drug Administration–approved transcatheter valve replacement for patients with ≥ moderate, symptomatic tricuspid regurgitation despite optimal medical therapy.

Techniques:

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left panel: TEE images. (a) RV inflow view. Posterior (P) and anterior (A) leaflets visible. This also shows a prominently long Eustachian valve (∗). (b) RV outflow view. Septal (S) and anterior (A) leaflets visible. (c and d) Color demonstrating torrential tricuspid regurgitation. Right panel: (e and f) CT cardiac angiography with measurements of the TVA. (g and h) CT overlay images generated using 3Mensio (Pie Medical imaging, Netherlands) showing the relationship of IVC and TV annulus in (g) coplanar view and (h) en face view showing there is overlap of the IVC and TV annulus, which is predictive of a favorable TTVR anatomy for right-sided femoral approach. Abbreviations: CT, computed tomography; EV, Eustachian valve; IVC, inferior vena cava; RV, right ventricle; TEE, transesophageal echocardiography; TTVR, transcatheter tricuspid valve replacement; TV, tricuspid valve; TVA, tricuspid valve annulus.

Article Snippet: The EVOQUE transcatheter tricuspid valve (TV) replacement (TTVR) system (Edwards Lifesciences, Irvine, California) is the first and only Food and Drug Administration–approved transcatheter valve replacement for patients with ≥ moderate, symptomatic tricuspid regurgitation despite optimal medical therapy.

Techniques: Generated, Imaging, Computed Tomography

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: (a–c) CT cardiac angiography with measurements of the RV and RA in diastole and systole. Favorable RA height (>60 mm) and RV working room to accommodate the EVOQUE capsule. (d) Three-dimensional reconstruction reveals a prominent EV and distance to the TVA of 24.6 mm. In our cases, we have observed that EV–TVA distance <25 mm would favor a left femoral approach. (e) IVC centerline to TVA distance of 31.9 mm. In our experience, centerline IVC–TVA distance of <40 mm could potentially lead to inadequate working room length, and we favor a left-sided approach. In this case, despite a large RA height, we were unable to gain adequate RA height from the right- and left-sided approach. Abbreviations: CT, computed tomography; EV, Eustachian valve; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; TVA, tricuspid valve annulus.

Article Snippet: The EVOQUE transcatheter tricuspid valve (TV) replacement (TTVR) system (Edwards Lifesciences, Irvine, California) is the first and only Food and Drug Administration–approved transcatheter valve replacement for patients with ≥ moderate, symptomatic tricuspid regurgitation despite optimal medical therapy.

Techniques: Computed Tomography

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Anatomical requirement for anterior tilted deployment of EVOQUE valve. The crimped valve length from the loading tabs to the anchor tips is between 51 mm and 54 mm based on the valve size. At final release, the distance from the loading tabs to the flipped anchor tips is 17 mm. If the capsule edge is <35 mm below the annulus, the anchors will have adequate room to flip to the TV hinge points by final release without chordal entrapment. Abbreviation: TV, tricuspid valve.

Article Snippet: The EVOQUE transcatheter tricuspid valve (TV) replacement (TTVR) system (Edwards Lifesciences, Irvine, California) is the first and only Food and Drug Administration–approved transcatheter valve replacement for patients with ≥ moderate, symptomatic tricuspid regurgitation despite optimal medical therapy.

Techniques:

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Top panel: Progressive exposure of the anchors and ventricular flip of the anchors while simultaneously adding primary flex to correct the anterior trajectory and become coaxial to the TV annular plane. The white interrupted line represents the approximate plane of the TV annulus. Bottom panel: ICE multiplanar reconstruction images demonstrating the progressive ventricular flip of the EVOQUE anchors. Abbreviation: ICE, intracardiac echo; TV, tricuspid valve.

Article Snippet: The EVOQUE transcatheter tricuspid valve (TV) replacement (TTVR) system (Edwards Lifesciences, Irvine, California) is the first and only Food and Drug Administration–approved transcatheter valve replacement for patients with ≥ moderate, symptomatic tricuspid regurgitation despite optimal medical therapy.

Techniques:

Journal: Structural Heart

Article Title: Anterior Tilted Deployment of EVOQUE Transcatheter Tricuspid Valve Replacement System: Overcoming Inadequate Implant Depth

doi: 10.1016/j.shj.2026.100816

Figure Lengend Snippet: Left image: Ventricular expansion of the EVOQUE frame demonstrating engagement of the anchors evenly beneath the anterior, posterior, septal, and lateral portions of the TV annulus. Right image: Ventricular expansion of the EVOQUE frame. White interrupted line represents the approximate plane of the TV annulus. There is a mild anterior-to-posterior trajectory, which was corrected by the final release. Abbreviation: TV, tricuspid valve.

Article Snippet: The EVOQUE transcatheter tricuspid valve (TV) replacement (TTVR) system (Edwards Lifesciences, Irvine, California) is the first and only Food and Drug Administration–approved transcatheter valve replacement for patients with ≥ moderate, symptomatic tricuspid regurgitation despite optimal medical therapy.

Techniques: