Zipping Versus Clover Repair in Transcatheter Edge-to-Edge Tricuspid Repair: Insights From the TRI-SPA Registry

Transcatheter edge-to-edge repair is an established treatment for tricuspid regurgitation (TR) in nonoptimal surgical candidates. Two techniques have been described: zipping (or bicuspidization) and clover (or triple-orifice). This study aimed to compare the echocardiographic and clinical outcomes of these 2 techniques.

This multicenter registry included 288 patients undergoing tricuspid transcatheter edge-to-edge repair from June 2020 to December 2024. Patients were categorized into 2 groups (zipping and clover repairs). The primary study end point was the TR reduction at follow-up. The secondary end point was the composite of all-cause mortality and heart failure hospitalization at follow-up.

The median age was 77 years (interquartile range, 73-82), with 203 females (70.5%) and a median TRISCORE of 4.1±1.8. Of these, 197 patients (68.4%) underwent zipping repair, while 91 (31.6%) received the clover repair technique. The median follow-up duration was 11.6 months (interquartile range, 4.5-21.2). Patients treated with the clover technique experienced lower rates of residual TR ≤2+ (76% versus 89%, P=0.006) and higher single-leaflet device attachment in the follow-up, attributed to a higher prevalence of complex tricuspid valve anatomy. Similar rates of the composite end point were observed among the groups without differences in New York Heart Association functional class (P=0.835) and TR reintervention at 1-year (P=0.196).

Residual TR was more common in patients treated with the clover technique, owing to the higher prevalence of complex tricuspid valve anatomy. Clinical outcomes were similar between the zipping and clover techniques. Both approaches represent viable and effective treatment options for managing TR.