Key result
Multiparametric 3D echo and hemodynamics improve residual regurgitation assessment post-TEER despite lacking standardized validation.
Intraprocedural assessment of residual MR and TR after TEER requires an integrated multiparametric approach combining advanced 3D echocardiography and hemodynamic measures, as standardized standalone criteria remain lacking.
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Challenges in intraprocedural regurgitation assessment after TEER warrant multiparametric caution; leaves open standardized protocols for clinical adoption.
AIMS: Transcatheter edge-to-edge repair (TEER) has emerged as an established therapeutic option for selected patients with severe mitral (MR) and tricuspid regurgitation (TR), supported by expanding clinical evidence. However, intraprocedural assessment of residual regurgitation remains challenging because of dynamic hemodynamic changes, device-related artefacts, and limitations of conventional echocardiographic parameters. METHODS AND RESULTS: This review summarizes current evidence on multiparametric echocardiographic and hemodynamic assessment during mitral (M-TEER) and tricuspid (T-TEER) procedures, with a focus on the evaluation of residual regurgitation, the immediate physiological response, markers of cardiac remodeling and their prognostic implications. Accurate quantification of residual MR and TR requires an integrated multiparametric approach. Residual regurgitation is associated with clinical outcomes and reverse remodeling. Conventional two-dimensional measures are limited by altered post-procedural jet geometry and multiple residual jets. Three-dimensional vena contracta area provides improved visualization and quantification of residual regurgitation, enabling summation of multiple jets. However, its quantitative accuracy has been validated only to a limited extent and thresholds after TEER are not standardized. Volumetric quantification is independent of jet geometry but remains insufficiently validated intraprocedurally. Atrial pressures, venous flow and forward flow describe the physiological response rather than regurgitant severity. CONCLUSION: Intraprocedural evaluation of residual MR and TR after TEER requires expert integration of multiple echocardiographic measures of regurgitation with complementary assessment of its physiological consequences and hemodynamic parameters. Advanced 3D imaging plays an increasingly central role in improving procedural assessment and post-interventional risk stratification, but standardized and validated criteria for quantifying residual regurgitation after TEER are still lacking.
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Pasquini et al. (2026) conducted a review in Severe mitral and tricuspid regurgitation. Multiparametric echocardiographic and hemodynamic assessment during mitral and tricuspid transcatheter edge-to-edge repair was evaluated on Quantification of residual mitral and tricuspid regurgitation and prognostic implications. Multiparametric 3D echocardiographic and hemodynamic assessment improves residual regurgitation quantification after TEER, though standardized validation criteria are still lacking.
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