Transcatheter Edge-to-Edge Repair Increases Annular Forces in In Vitro Whole Heart Preparations

Background Tricuspid transcatheter edge-to-edge repair (TEER) can induce an acute annuloplasty effect. While this has a therapeutic benefit, the mechanisms driving the reduction in annular size remain unclear. Objectives We quantify the annular force induced by TEER in vitro in whole porcine heart preparations. We explore the impact of clipping different leaflet pairs on the TEER-induced annular forces. Methods We performed 49 interventions in 13 porcine hearts using a MitraClip XT. The clip was implanted between either the anterior-septal (AS), anterior-posterior (AP), or posterior-septal (SP) leaflet pairs. We also considered two-clip interventions between the combination of the AS-AP, AS-PS, or AP-PS leaflet pairs. For each intervention, we measured the right ventricular pressure, transvalvular flow rate, and force at eight locations around the annulus. Results TEER induced significant inward-pulling forces on the annulus. The maximum force was induced following an AS-PS two-clip intervention. A single AS clip induced the largest force among the one-clip interventions. Furthermore, the AP and AS-AP interventions induced the smallest annular forces. Conclusions The magnitude of the TEER-induced force depends on the intervention and number of clips implanted.