{"id":"66b19b63acd3","type":"article","url":"https://hartvaat.nl/2026/03/23/triplace-register-paravalvulaire-lekkage-na-transkatheter-tricuspidalisklepverva/","title":"TRIPLACE-register: paravalvulaire lekkage na transkatheter-tricuspidalisklepvervanging","title_en":"Incidence, Clinical Implications, and Predictors of Paravalvular Leak Following Transcatheter Tricuspid Valve Replacement: The TRIPLACE Registry","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JACC. Cardiovascular interventions","doi":"10.1016/j.jcin.2026.01.281","source_url":"https://doi.org/10.1016/j.jcin.2026.01.281","authors":["Andrea Scotti","Azeem Latib","Annalisa Filtz","Matteo Sturla","Firas Zahr","Robert Boone","Susheel Kodali","Didier Tchétché","Ole De Backer","Augustin Coisne","Sebastian Ludwig","Santiago A Garcia","Lukas Stolz","Rodrigo Estevez Loureiro","Matti Adam","Federico De Marco","Edwin C Ho","Anson Cheung","Matteo Biroli","Alexandru Patrascu","Sami Alnasser","Scott Chadderdon","Davorka Lulic","Joanna Bartkowiak","Julio Echarte-Morales","Horst Sievert","Timothy Byrne","Francesco Maisano","Christian Frerker","Nicolas Dumonteil","Omar A Oliva","Tanja K Rudolph","Felix Rudolph","Raviteja Guddeti","Beka Bakhtadze","Amar Krishnaswamy","Samir R Kapadia","Juan Del Portillo","Josep Rodés-Cabau","Niklas Schofer","Ignacio Cruz-Gonzalez","Juan Granada","Jörg Hausleiter","Rebecca T Hahn","Thomas Modine","Neil Fam","Rishi Puri"],"significance":7,"published":"2026-03-23","source_date":"2026-03-23","image":"","kennis":[],"congress":"","summary_en":"The international TRIPLACE registry examined the incidence and prognostic impact of paravalvular leak (PVL) after transcatheter tricuspid valve replacement (TTVR) in 394 patients. Moderate-to-severe PVL occurred in 6.1% and was associated with markedly higher 1-year mortality (39.7% vs ~11%; adjusted HR 2.6) and worse functional class. Larger right-atrial volume, device malposition and type IV valve morphology were independent predictors. The findings have implications for future TTVR device design and procedural optimisation.","created":"2026-07-03T10:32:17Z","updated":"2026-07-03T13:31:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In het internationale TRIPLACE-register werd na transkatheter-tricuspidalisklepvervanging (TTVR) bij 394 patiënten de incidentie en prognostische impact van paravalvulaire lekkage (PVL) onderzocht. Matige tot ernstige PVL trad op bij 6,1% en ging gepaard met een fors hogere 1-jaarssterfte (39,7% versus circa 11%; gecorrigeerde HR 2,6) en een slechtere functionele klasse. Een groter rechter-atriumvolume, malpositie van de klep en type IV-klepmorfologie waren onafhankelijke voorspellers. De bevindingen hebben implicaties voor het toekomstige ontwerp van TTVR-systemen en voor procedurele optimalisatie.","abstract_original":"BACKGROUND: The clinical efficacy of transcatheter tricuspid valve replacement (TTVR) in abolishing tricuspid regurgitation might be attenuated by the occurrence of paravalvular leak (PVL). OBJECTIVES: The aim of this study was to investigate the incidence, outcomes, and predictors of moderate or severe PVL post-TTVR. METHODS: All eligible patients undergoing TTVR in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry were stratified according to predischarge PVL severity. The primary endpoint was the occurrence of moderate or severe PVL post-TTVR. Secondary endpoints were 1-year mortality, 1-year heart failure hospitalization, and post-TTVR NYHA functional class III or IV. Outcomes were analyzed using logistic regression (PVL), Cox regression (mortality), and Gray's test (heart failure). RESULTS: Of 394 TTVR patients, 24 (6.1%) had moderate or severe, 88 (22.3%) mild, and 282 (71.6%) no or trace PVL post-TTVR. Patients with moderate or severe PVL had significantly higher TRI-SCOREs (P < 0.001), lower estimated glomerular filtration rates (P = 0.001), and larger right ventricular and right atrial dimensions (P = 0.002 for both). Patients with moderate or severe PVL post-TTVR had worse 1-month functional class (53% in NYHA functional class III or IV) than those with mild (16%) or no or trace (15%) PVL. The presence of moderate or severe PVL post-TTVR was associated with increased 1-year mortality (39.7%; adjusted HR: 2.6; 95% CI: 1.2-5.7) compared with those with mild (12.6%) or no or trace (10.5%) PVL. A larger right atrial volume (P = 0.02), device malposition (P = 0.0002), and type IV valve morphology (P = 0.01) were independently associated with moderate or severe PVL post-TTVR. CONCLUSIONS: Moderate or greater PVL occurred in 6.1% of patients post-TTVR and was associated with increased 1-year mortality and worse functional status. A larger right atrial volume, device malposition, and type IV valve morphology conferred a higher risk for developing moderate or severe PVL post-TTVR. These findings have important implications for future TTVR design and procedural optimization. (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement [TRIPLACE]; NCT06033274)."}