Personalized Guidance of Edge-to-Edge Transcatheter Tricuspid Valve Repair by Multimodality Imaging

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Technology

Background:

• Transcatheter edge-to-edge tricuspid valve repair (T-TEER) for tricuspid regurgitation (TR) traditionally relies on transesophageal echocardiography (TEE).
• Patient-specific anatomy and acoustic windows necessitate advanced imaging strategies for optimal T-TEER procedural planning and guidance.
• Integrating transthoracic echocardiography (TTE) and cardiac CT with TEE offers a potential solution for personalized T-TEER guidance.

Purpose of the Study:

• To evaluate the efficacy and outcomes of a personalized, multimodality imaging (MMI) guidance approach for T-TEER.
• To compare MMI guidance with conventional TEE guidance in T-TEER procedures.
• To assess the impact of MMI on procedural success, complication rates, and long-term quality of life.

Main Methods:

• A cohort of 40 patients undergoing T-TEER was divided into MMI (n=17) and TEE-only (n=23) guidance groups based on TTE acoustic window quality.
• MMI involved cardiac CT for planning specific fluoroscopic views and primary guidance with TTE, supplemented by TEE for critical steps.
• Both TTE and TEE images were correlated with CT and fluoroscopy for precise anatomical alignment and procedural execution.

Main Results:

• The primary efficacy endpoint (≥1-grade TR reduction at 30 days) was achieved in 94% of MMI patients versus 91% of TEE-only patients.
• Device success was 100% in both groups, with no device-related complications.
• The MMI group experienced no TEE-associated gastrointestinal bleeding, unlike three cases in the TEE-only group. Both groups showed significant improvements in NYHA functional class and quality of life at 12 months.

Conclusions:

• Multimodality imaging (MMI) guidance is an effective strategy for T-TEER, particularly in patients with adequate TTE acoustic windows.
• This personalized approach may mitigate risks of gastroesophageal injury associated with TEE probe manipulation.
• Successful TR reduction, regardless of guidance method, significantly improves long-term quality of life.