Introduction: Mechanical disruption of tricuspid valve apparatus function can occur when right ventricular leads from cardiac implantable electronic devices [CIEDs] are placed. The lead-valve interaction can result in valvular stretch and deformity; altered valve mechanics; and lead impingement on or adherence to a leaflet, causing laceration or perforation of the leaflet or sub-valvular apparatus. Additionally, chronic inflammatory changes around a lead can cause fibrosis and scarring of perivalvular tissues, leading to changes in valve alignment and coaptation, and further functional impairment. The resulting tricuspid regurgitation [TR] from these mechanical distortions secondarily causes right ventricular dilation and impairment, often forming a substrate for functional TR. Methods: We present a case series of 5 patients with CIEDs who underwent percutaneous removal of pacing leads followed by tricuspid valve replacement in a New South Wales tertiary hospital for severe lead associated TR and associated right heart failure sequalae. We analyse their baseline characteristics, management pathways and postoperative outcomes. Summary: CIED lead associated severe TR is a complex clinical challenge. In our centre, patients who fail conservative management undergo lead extraction and valve surgery as separate procedures in the same admission. Tricuspid valve replacement is preferred over repair due to structural tricuspid valve apparatus changes from mechanical and inflammatory effects of pacing leads. This case series highlights the need for a refined management approach. It’s purpose is to inform a treatment management algorithm and act as impetus to improve valve design and lead placement techniques. In conclusion, our findings support that an approach involving lead extraction and tricuspid valve replacement with lead reimplantation if indicated in the same admission is an effective method for addressing severe CIED lead associated severe TR.