In this episode of Nail it with Nadira, Dr Firas Zahr traces the development of the Intrepid transcatheter tricuspid valve replacement (TTVR) system from its origins as a transcatheter mitral valve platform to its latest tricuspid-specific iteration. He reviews the key engineering changes made throughout the early feasibility programme, including a smaller delivery system, softer valve frame, reduced ventricular interaction and expanded sizing designed to accommodate larger tricuspid anatomies.

Dr Zahr explains how lessons learned from the first 150 patients treated have influenced procedural techniques, patient selection and device design. He also discusses which anatomical characteristics may make patients suitable for Intrepid TTVR, how evolving technology has reduced some of the early procedural limitations, and the considerations surrounding conduction-system interaction and pacemaker implantation.

The conversation also explores the planned global pivotal trial, including its randomised design, comparison with the Edwards EVOQUE platform and the long-term aim of establishing the safety, effectiveness and durability of TTVR. Hear how experienced operators are approaching the ongoing challenge of right ventricular dysfunction, afterload mismatch and individualised patient assessment as transcatheter tricuspid therapies continue to evolve.