Acute tricuspid valve annulus remodeling after transcatheter edge-to-edge repair with Triclip
Authors: Antonelli G , De Luca V M , Cammalleri V , Piscione M G , Carpenito M , Mega S , Grigioni F , Ussia G P 
Published: January 2025

Abstract

Background
Right ventricular (RV) adverse remodeling together with RV dysfunction, and not only tricuspid regurgitation (TR) severity, are independently associated with survival in patients with medically treated significant TR. Nevertheless, changes in RV dimensions and function after transcatheter tricuspid valve intervention and their association with outcomes remain largely unexplored, as well as tricuspid valve annulus (TVA) reverse remodeling.
Aim of our study is to assess acute remodeling of TVA after tricuspid transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott Vascular, Santa Clara, CA, USA) using intraprocedural trans-esophageal echocardiography (TEE).

Materials and methods
This prospective, single-center study, conducted at Fondazione Policlinico Universitario Campus Bio-Medico of Rome, enrolled 60 consecutive symptomatic patients referred with the diagnosis of at least severe TR who underwent T-TEER from March 2021 to June 2024 with the TriClip System. Intraprocedural TEE was performed using Siemens Acuson SC2000 (Siemens Medical Systems, Pleasanton, CA, USA) at the beginning, and then using Philips EpiQ CVx (Philips Medical System, Andover, MA). A full-volume 3D echocardiographic data set was acquired during the procedure for each patient before and after the grasping. The following parameters were assessed using a multiplanar reconstruction analysis performed off-line using a 3D dataset: septal-lateral (SL) and antero-posterior (AP) annulus diameters; annulus area; annulus perimeter and eccentricity index.

Results
The mean age of the study cohort was 77,77 ± 6,18 years, and 77% were female. Twenty-eight patients (46,7%) had severe (3+), twenty-four patients (40%) massive (4+) and eight patients (13,3%) torrential (5+) tricuspid regurgitation. The majority of them had atrial functional tricuspid regurgitation, mostly due to annular dilatation. The acute procedural success was achieved in 82.22%. We observed an acute reduction in SL (from a median of 45 to 38 mm, p&lt;0.0001), AP (from a median of 47.5 to 45.8 mm, p&lt;0.0001), area (from a median of 18.4 to 16.2 cm2, p&lt;0.0001), perimeter (from a median of 149 to 141 mm, p&lt;0.0001) and eccentricity index (from 0.92 to 0.87, p &lt;0.0001). The TV annulus was larger in patients with residual TR &gt;2+. Analysis of the subgroups according to procedural success showed an acute inverse remodeling of the TV annulus independent of residual TR grade. We observed a significative reduction of TVA three-dimensional measurements immediately after the procedure.

Conclusions
In our study we observed that the reduction of TVA begins immediately after TriClip implantation, proving that T-TEER is effective in reducing TR and in inducing reverse remodeling of the TV apparatus. Concurrently, the baseline TV geometry influences the procedural results. Our data are gathered during T-TEER procedure, follow up data are needed for monitoring right ventricular performance.
tva measures using mpr
tr grade at baseline and after t-teer