Clinical Safety and Efficacy of the VDyne Transcatheter Tricuspid Valve Replacement System for the Treatment of Tricuspid Regurgitation ( VISTA-US)

Inclusion Criteria:

• Symptomatic severe tricuspid valve regurgitation of primary or secondary etiology.

• NYHA class ≥ II. If NYHA Class IV, patient must be ambulatory.

• Subject is adequately treated with medical therapy for heart failure ≥ 30 days priorto

• index procedure, including a diuretic.

• Heart Team determines patient is a recommended candidate for the VDyne System.

• Age >18 years at time of index procedure.

• Clinical Screening Committee (CSC) and Imaging Core Labs confirm suitability fortreatment with the VDyne System.

Exclusion Criteria:

• Patient anatomy (cardiac and vascular) is not suitable for VDyne System as assessedby Imaging Core Labs, Sponsor or Clinical Screening Committee (CSC)

• Intolerance to procedural anticoagulation or post-procedural antiplatelet/anticoagulation regimen that cannot be medically managed

• Hypersensitivity to nickel or titanium

• Left Ventricular Ejection Fraction (LVEF) <30%.

• Severe RV dysfunction.

• Significant abnormalities of the tricuspid valve and sub-valvular apparatus.

• Sepsis including active infective endocarditis (IE) (within last 6 months).

• Right ventricular, atrial thrombus, vegetation or mass on tricuspid valve.

• Severe tricuspid annular or leaflets calcification.

• Systolic pulmonary hypertension with systolic pulmonary artery pressure >70 mmHg.

• History or rheumatic fever

• Significant coronary artery disease requiring treatment such as symptomatic,unresolved multi-vessel or unprotected left main coronary artery disease.

• Any planned surgery or interventional procedure within 30 days prior to or 30 daysfollowing the implant procedure. This includes any planned concomitantcardiovascular procedure such as CABG, PCI, pulmonary vein ablation, left atrialappendage occlusion, septal defect repair, etc.

• Unresolved severe symptomatic carotid stenosis (> 70% by ultrasound).

• Cardiac resynchronization therapy device or implantable pulse generator implantedwithin 60 days of planned implant procedure.

• Permanent pacing leads that will interfere with delivery or implantation of theVDyne Valve.

• Cardiogenic shock or hemodynamic instability requiring inotropes or mechanicalsupport devices at the time of planned implant procedure.

• Prior tricuspid valve surgery or catheter-based therapy with permanent residualdevice(s) implanted that would preclude delivery or implantation of the VDyne Valve (e.g. valve replacement, edge to edge repair, etc.).

• Significant valvular heart disease requiring intervention other than the tricuspidvalve.

• Known significant intracardiac shunt (e.g. septal defect)

• Cerebrovascular accident (stroke, TIA) within 6 months of treatment procedure.

• Severe lung disease (severe COPD or continuous use of home oxygen or oral steroids).

• Acute myocardial infarction (AMI) within 30 days.

• Significant renal dysfunction (eGFR<30 ml/min/1.73m2) or on dialysis.

• End-stage liver disease (MELD > 11 / CHILD class C).

• Bleeding requiring transfusion within prior 30 days.

• Coagulopathy or other clotting disorder that cannot be medically managed.

• Chronic immunosuppression or other condition that could impair healing response.

• Any of the following: leukopenia, chronic anemia (Hgb < 9), thrombocytopenia,history of bleeding diathesis, or coagulopathy.

• Unwilling to receive blood products.

• Known hypersensitivity or contraindication to procedural or post-proceduralmedications (e.g., contrast solution) which cannot be adequately managed medically.

• Life expectancy less than 12 months due to non-cardiac comorbidities.

• Treatment is not expected to provide benefit (futile).

• Current IV Drug user (must be free drug abuse for > 1 year).

• Pregnant, lactating or planning pregnancy within next 12 months.

• Vulnerable patient groups (minors, cognitively impaired persons, prisoners, personswhose willingness to volunteer could be unduly influenced by the expectation ofbenefits associated with participation or of retaliatory response from seniormembers of a hierarchy in case of refusal to participate, such as students,residents, and employees).

• Currently participating in an investigational drug or device trial that has notreached its primary endpoint or is likely to interfere with this study.

• Patient (or legal guardian) unable or unwilling to provide written, informed consentbefore study enrollment.

• Patient unable or unwilling to comply with study required testing and follow-upvisits