Key result
4D-ICE matches TEE guidance for lesion identification and residual regurgitation assessment in T-TEER.
Why the study?
Transesophageal echocardiography is the gold-standard imaging for guiding transcatheter tricuspid edge-to-edge repair but has limitations including need for general anesthesia and image shadowing.
Does 4D intracardiac echocardiography (4D-ICE) provide comparable imaging guidance to transesophageal echocardiography (TEE) during transcatheter tricuspid edge-to-edge repair in high-risk patients?
Observational (n=10)
No
Does 4D intracardiac echocardiography (4D-ICE) provide comparable imaging guidance to transesophageal echocardiography (TEE) during transcatheter tricuspid edge-to-edge repair in high-risk patients?
4D-ICE is a feasible and potentially advantageous alternative to TEE for guiding transcatheter tricuspid edge-to-edge repair, particularly for patients unsuited for TEE or with complex imaging windows.
Answers are grounded in this paper and cite their sources.
May support 4D-ICE as TEE alternative in high-risk T-TEER; leaves open prospective validation of equivalence.
Tricuspid regurgitation is a common valvular disease associated with high morbidity and mortality if left untreated. While surgery has been the standard intervention, transcatheter tricuspid edge-to-edge repair (T-TEER) has emerged as an alternative for high-risk surgical candidates. Transesophageal echocardiography (TEE) is the gold-standard imaging modality for guiding T-TEER due to its high spatial and temporal resolution. However, it requires general anesthesia and esophageal intubation, limiting its use in certain patients. Additionally, TEE image quality may be compromised by anterior structure shadowing, which is common in T-TEER. The development of 4D intracardiac echocardiography (ICE) offers real-time, three-dimensional imaging, potentially overcoming these limitations. This study compared TEE and Acuson AcuNav 4D-ICE in guiding T-TEER in ten high-risk patients across eight crucial procedural steps. ICE showed optimal feasibility in key procedural steps, including valve steering and leaflet grasping, due to its proximity to target structures, minimizing shadowing artifacts. Both modalities performed equally in lesion identification and residual regurgitation assessment and achieved non-statistically different results in most quantitative measurements. This study supports the integration of 4D-ICE into T-TEER procedures, particularly for patients unsuited for TEE or with complex TEE windows. Its real-time imaging, reduced invasiveness, and feasibility in critical steps highlight its potential as a viable alternative or complement to TEE. Further multicenter studies are needed to validate its role, optimize protocols, and evaluate long-term outcomes in 4D-ICE-guided T-TEER.
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Biroli et al. (2025) conducted an observational in Tricuspid regurgitation (n=10). Acuson AcuNav 4D-ICE (4D Intracardiac Echocardiography) vs. Transesophageal echocardiography (TEE) was evaluated on Performance across eight crucial procedural steps including valve steering, leaflet grasping, lesion identification, and residual regurgitation assessment. In 10 high-risk patients, 4D-ICE demonstrated optimal feasibility for guiding T-TEER and performed equally to TEE in lesion identification and residual regurgitation assessment.
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