29 Outcomes following orthotopic transcatheter tricuspid valve replacement in patients with cardiac implantable electronic device endocardial leads: the triplace registry
Bibliographic record
Abstract
Background Transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment in addition to medical therapy in severe or greater tricuspid regurgitation (TR). Patients undergoing orthotopic TTVR frequently present with a cardiac implantable electronic device (CIED) lead across the tricuspid valve (TV). Aims We sought to investigate the clinical, procedural and lead-related outcomes for patients with a CIED lead across the TV during orthotopic TTVR. Methods All consecutive patients enrolled in the multicenter TRIPLACE registry (NCT06033274) were included for analysis. TTVR was performed at 19 centers using 8 different platforms between June 2018 and April 2025. 60 patients had sufficient data allowing lead function parameter analysis. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion. Results Baseline demographic, clinical, procedural and CIED lead characteristics are outlined in table 1. Procedural, follow-up and CIED lead outcome data are outlined in table 2. Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual TR (82.6% vs. 91.4%, p<0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs. 7.1%, p<0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. Univariable Fine-Gray competing risks regression analysis results, identifying predictors of lead failure, are outlined in table 3. No significant increase in adverse events or mortality was observed at 30 days. Conclusion Orthotopic TTVR in patients can be safely and effectively performed in the presence of a transvalvular CIED lead with low rates of lead failure. Significant paravalvular leak and residual TR is more common with a jailed lead. These patients require close CIED follow up with alternative pacing strategies in place, particularly when pacing dependent.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".