Lucky Luke in the Cath lab? Use of a snare catheter to optimize positioning in transcatheter tricuspid valve replacement: a case report.

Background: Transcatheter tricuspid valve replacement (TTVR) has emerged as a therapeutic option for patients with severe tricuspid regurgitation (TR) who are unsuitable for transcatheter edge-to-edge repair (T-TEER). While procedural outcomes continue to improve, device delivery remains a critical step and may be particularly challenging in complex anatomies. Case summary: We report on a 75-year-old patient with heart failure and severe TR of mixed aetiology with a history of cardiac resynchronization therapy (CRT). Surgical repair was deemed prohibitive due to high surgical risk, and transcatheter edge-to-edge repair was unfavorable, given the large coaptation gap. According to the Heart Team decision, TTVR using the Evoque system was planned. Intraprocedurally, conventional manoeuvres failed to achieve appropriate device positioning and delivery into the right ventricle. By employing a snare catheter and a steerable sheath, the delivery could be stabilized and guided into the correct position. This strategy ensured successful valve deployment at optimal depth, resulting in excellent valve function with only minimal paravalvular leakage. Discussion: Even with careful preprocedural planning with computed tomography, intraprocedural device delivery during TTVR can be challenging and result in procedural failure. The present case highlights the feasibility of combining a snare catheter with a steerable sheath to optimize device depth positioning and delivery, thereby ensuring procedural success in patients with challenging anatomies. Broader awareness and dissemination of such adjunctive techniques may expand the applicability of TTVR in anatomically challenging scenarios.