Transcatheter Edge-to-Edge Repair of Tricuspid Regurgitation With TriClip: A Step-by-Step Guide

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Devices

Background:

• Tricuspid regurgitation (TR) is increasingly recognized as a progressive disease linked to significant morbidity and mortality.
• Current treatment limitations include lack of effective medical therapies and high surgical risks.
• Tricuspid transcatheter edge-to-edge repair (T-TEER) presents a minimally invasive option for symptomatic severe TR in high-risk patients.

Purpose of the Study:

• To provide a comprehensive review of the TriClip system for T-TEER.
• To outline a step-by-step approach to TriClip implantation, including patient selection, imaging, and techniques.
• To discuss intra-procedural challenges, troubleshooting, and post-procedural management.

Main Methods:

• Review of anatomical and pathophysiological factors relevant to T-TEER.
• Detailed description of TriClip implantation procedures, emphasizing transesophageal echocardiography guidance.
• Analysis of intra-procedural and post-procedural management strategies.
• Comparative analysis of TriClip and PASCAL systems.
• Exploration of combined mitral and tricuspid TEER.

Main Results:

• Evidence from trials and registries supports the safety, feasibility, and durability of TriClip-based T-TEER.
• Transesophageal echocardiography is critical for successful device guidance and procedural confirmation.
• Combined mitral and tricuspid TEER shows early promise for safety and efficacy.

Conclusions:

• T-TEER with the TriClip system is a viable, minimally invasive alternative for high-risk patients with severe TR.
• The procedure requires careful patient selection, meticulous technique, and comprehensive post-procedural care.
• T-TEER is poised to become a key treatment modality for functional TR in high-risk populations as technology and experience advance.