Transcatheter tricuspid valve replacement with EVOQUE™ in arrhythmogenic right ventricular cardiomyopathy: insights from the first-in-man case report

Background: Severe functional tricuspid regurgitation (TR) in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVC) represents a challenging clinical entity, often complicated by progressive right ventricular (RV) dysfunction and limited interventional options. Case summary: We report the first worldwide case of successful transcatheter tricuspid valve replacement (TTVR) with the EVOQUE™ system in a 37-year-old patient with ARVC, severe TR, and a cardiac resynchronization therapy defibrillator (CRT-D), following failed transcatheter edge-to-edge repair (TEER). The procedure resulted in immediate elimination of TR and the patient experienced marked symptomatic improvement. Discussion: This case highlights the feasibility of TTVR in complex RV pathology, underscoring procedural considerations such as lead-valve interaction, risk of afterload mismatch, and prevention of right heart failure. TTVR with the EVOQUE™ system is feasible in selected patients with ARVC, severe functional TR, prior failed repair, and existing CRT-D leads. Success depends on meticulous pre-procedural planning, intra-procedural imaging, and vigilant haemodynamic management to mitigate RHF risk. This case broadens the spectrum of structural interventions in patients with ARVC and symptomatic TR not suitable for surgery or TEER and supports consideration of TTVR as a bridge-to-transplant strategy.