Clip Liberation to Facilitate Transcatheter Tricuspid Valve Replacement (CLEFT)

Transcatheter tricuspid valve edge-to-edge repair (T-TEER) can be effective for patients with tricuspid regurgitation (TR), but TR may recur, requiring transcatheter tricuspid valve replacement (TTVR). Although TTVR has been described in patients with single leaflet device attachment of edge-to-edge devices, implantation in presence of well-attached devices has not been described.

We present a patient with recurrent TR after T-TEER. Transesophageal echocardiography revealed that 3 previously placed MitraClip XTW devices were well attached to the tricuspid leaflets, with recurrent severe TR. After laceration of 1 leaflet attached to the central XTW clip with transcatheter electrosurgery, we implanted an EVOQUE TTVR with trivial paravalvular leakage.

Transcatheter electrosurgery can free a tricuspid clip from leaflets, allowing implantation of an EVOQUE TTVR with excellent TR resolution.

Transcatheter electrosurgical liberation of T-TEER devices might be a viable technique in patients who require a TTVR for recurrent tricuspid regurgitation.