Continuous Hemodynamic Monitoring During Transcatheter tricuspid valve repair: Insights from Pulse Contour – Based Assessment

Abstract Objectives This exploratory pilot study evaluates the effectiveness of pulse contour analysis (PCA) as a tool for real-time hemodynamic monitoring in patients undergoing transcatheter edge-to-edge valve repair of the tricuspid valve (T-TEER). Additionally, it examines whether continuous PCA monitoring can identify indicators of procedural success and improve perioperative management. Design Prospective, hypothesis-generating pilot single-center study. Setting Single tertiary care university hospital. Participants A total of 12 patients undergoing T-TEER. Interventions Real-time PCA was used throughout the entire intervention period from pre-operative assessment up to four hours post-procedure to monitor hemodynamic parameters (cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume variation (SVV), and blood pressure (BP)). Measurements & Main Results Four hours after T-TEER, CO-PCA had increased by 30% (p = 0.0124), accompanied by a 0.68 L/min/m² rise in CI (p = 0.008). T-TEER also resulted in a persistent reduction in SVV-PCA, with a sustained 3% decrease after the intervention (p = 0.009). Implantation of the first device triggered a notable peri-interventional increase in systolic arterial pressure of 17 mmHg (p = 0.026). In addition, the right-atrial v-wave decreased by 8 mmHg (p = 0.034). No meaningful changes in central venous oxygen saturation or central venous pressure were detected during or following the procedure (p = 0.73 and p = 0.27, respectively). Conclusions This study demonstrated that PCA using the FloTrackTM monitoring can provide valuable continuous hemodynamic information and characterize acute hemodynamic responses upon T-TEER. PCA detected meaningful hemodynamic improvements during T-TEER, characterised by increased CO, enhanced CI, and more stable preload conditions.