Outcomes of Intracardiac Echocardiography as the Primary Imaging Modality for Transcatheter Tricuspid Valve Procedures

Background: Tricuspid regurgitation (TR) is a high-mortality condition. While tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) improve quality of life, their reliance on transesophageal echocardiography (TEE) poses challenges. Intracardiac echocardiography (ICE) offers a promising adjunct; however, data on safety and efficacy remain limited. This study evaluates procedural characteristics, safety, and outcomes as operators gain experience with ICE for tricuspid procedures. Methods: Twenty-two patients with symptomatic ≥ severe TR treated with TTVR or T-TEER at Oregon Health & Science University were enrolled. All procedures utilized ICE and TEE. Patients were divided into 2 cohorts: cohort 1 primarily used TEE with adjunctive ICE (10 cases: 4 TTVRs and 6 T-TEERs), while cohort 2 primarily used ICE with adjunctive TEE (12 cases: 5 TTVRs and 7 T-TEERs). Procedural characteristics and outcomes were compared. Results: Mean TTVR procedure time decreased from 124 ± 38 minutes in cohort 1 to 98 ± 36 minutes in cohort 2, while T-TEER times dropped from 115 ± 35 minutes to 108 ± 30 minutes. Fluoroscopy time decreased from 27 ± 10 minutes to 19 ± 9 minutes for TTVRs and from 27 ± 11 minutes to 25 ± 10 minutes for T-TEERs. The TR grade was reduced by ≥ 2 grades in all but 1 patient with no mortality, bleeding events, or hospitalizations across all cohorts. Conclusions: Primary ICE strategy improves procedural efficiency while maintaining comparable safety and efficacy. Larger studies are needed to confirm these findings, as only 22 patients participated in this study, limiting statistical robustness.