In this episode of Nail it with Nadira, Dr Kashish Goel presents the Laplace transcatheter tricuspid valve replacement (TTVR) system, highlighting its unique anchoring mechanism, recapturable design and simplified procedural workflow. He explains how the device uses dedicated anterior and posterior flaps to secure the valve independently of the native leaflets, enabling treatment of a wide range of challenging anatomies, including severe leaflet tethering, carcinoid valve disease and patients with pacemaker or ICD leads.

Drawing on experience from the early feasibility study, Dr Goel reviews procedural techniques, anatomical screening criteria and the key role of the posterior shelf in successful implantation. He also shares outcomes from the growing international experience, including high procedural success rates, low mortality, single-digit pacemaker rates and consistent reduction of tricuspid regurgitation to mild or less severity.

The discussion explores how Laplace has been used in patients who were not candidates for other TTVR platforms, as well as the potential advantages of both transjugular and transfemoral access strategies. Hear how an experienced operator evaluates complex tricuspid anatomy, approaches patients with right ventricular dysfunction, and interprets the clinical improvements seen following complete elimination of tricuspid regurgitation. The session concludes with an overview of the newly approved pivotal trial and the future role of Laplace in the evolving TTVR landscape.