Tricuspid annulus remodelling after transcatheter edge-to-edge repair for reduction of tricuspid regurgitation

Background In the last years multiple transcatheter devices for tricuspid valve interventions were developed. Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device (TriClip Abbott Vascular, Santa Clara, CA, USA) for reduction of tricuspid regurgitation. Methods and results This is a retrospective dual-center cohort study that includes 26 consecutive patients, treated with TriClip in Maria Cecilia Hospital of Cotignola and in the University Hospital of Verona. Tricuspid annulus geometry was evaluated using three-dimensional transesophageal echocardiography examinations conducted during the procedure before and after TriClip implantation. The mean age of the study cohort was 79,3 years, and 88,5% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,44 cm vs 3,54 ± 0,53 cm, p=< 0,0001), mean major diameter (4,65 ± 0,63 cm vs 4,28 ± 0,65 cm, p=0,0002), planimetric area (14,00 ± 2,91 cm2 vs 11,25 ± 2,91 cm2, p=<0,0001) and perimeter (13,62 ± 1,43 cm vs 12,42 ± 1,62 cm, p=<0,0001) of the tricuspid annulus was observed. Conclusions In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to reduction in the tricuspid annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications.