Combined mitral and tricuspid TEER with a single TriClip steerable guide catheter: A single-center study

Structured Abstract Background Combined M- and T-TEER typically involves two separate systems, complicating logistics and increasing procedural risks. This study aims to evaluate the safety and efficacy of combined mitral (M-TEER) and tricuspid (T-TEER) transcatheter edge-to-edge repair using a single TriClip® steerable guide catheter (SGC). Methods Patients with moderate-to-severe (3+) or severe (4+) degenerative (DMR) or functional (FMR) mitral regurgitation and massive/torrential or severe functional tricuspid regurgitation (TR), classified as New York Heart Association (NYHA) class III or IV, who underwent combined M- and T-TEER with the same TriClip SGC between January 2022 and December 2024, were included. The primary objectives included procedural outcomes, MR and TR severity reduction, and NYHA class improvement. Results Among 42 patients (64% female; median age: 77 years [IQR: 9]], the implantation success rate was 100%, with mean device and procedure times of 39.2 ± 6.9 and 71.2 ± 9.6 minutes, respectively. There were no in-hospital or 30-day major adverse events (MAEs), except for 2 patients (4.8%) with tricuspid single leaflet device attachment (SLDA), and 1 patient (2.4%) who underwent atrial septal defect (ASD) closure. Over a median follow-up period of 0.91 years, 3 (7.1%) patients were hospitalized for heart failure, with zero mortality. At 1-year follow-up, all patients achieved NYHA class ≤II, along with MR ≤2+ and 34 (81%) patients had only trivial/mild TR. Conclusions Combined M-TEER and T-TEER using the same TriClip SGC demonstrated exceptional safety and efficacy, along with significant functional and echocardiographic improvements.