Key result
Transcatheter electrosurgical liberation of a previously placed tricuspid clip allowed successful implantation of an EVOQUE TTVR with trivial paravalvular leakage and excellent TR resolution.
Why the study?
TTVR implantation in the presence of well-attached edge-to-edge devices for recurrent tricuspid regurgitation after T-TEER had not been described.
Does transcatheter electrosurgical liberation of T-TEER devices allow for successful TTVR in patients with recurrent tricuspid regurgitation?
Case Report (n=1)
Does transcatheter electrosurgical liberation of T-TEER devices allow for successful TTVR in patients with recurrent tricuspid regurgitation?
Transcatheter electrosurgical liberation of previously placed T-TEER devices is a viable technique to facilitate TTVR in patients with recurrent tricuspid regurgitation.
May enable TTVR after failed tricuspid clipping in select patients; leaves open need for prospective safety and durability data.
BACKGROUND: Transcatheter tricuspid valve edge-to-edge repair (T-TEER) can be effective for patients with tricuspid regurgitation (TR), but TR may recur, requiring transcatheter tricuspid valve replacement (TTVR). Although TTVR has been described in patients with single leaflet device attachment of edge-to-edge devices, implantation in presence of well-attached devices has not been described. CASE SUMMARY: We present a patient with recurrent TR after T-TEER. Transesophageal echocardiography revealed that 3 previously placed MitraClip XTW devices were well attached to the tricuspid leaflets, with recurrent severe TR. After laceration of 1 leaflet attached to the central XTW clip with transcatheter electrosurgery, we implanted an EVOQUE TTVR with trivial paravalvular leakage. DISCUSSION: Transcatheter electrosurgery can free a tricuspid clip from leaflets, allowing implantation of an EVOQUE TTVR with excellent TR resolution. TAKE-HOME MESSAGE: Transcatheter electrosurgical liberation of T-TEER devices might be a viable technique in patients who require a TTVR for recurrent tricuspid regurgitation.
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Rajagopal et al. (2025) conducted a case report in Recurrent tricuspid regurgitation after T-TEER (n=1). Transcatheter electrosurgery for clip liberation followed by EVOQUE TTVR was evaluated on Tricuspid regurgitation resolution and paravalvular leakage. Transcatheter electrosurgical liberation of a previously placed tricuspid clip allowed successful implantation of an EVOQUE TTVR with trivial paravalvular leakage and excellent TR resolution.
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