The "Spider and the Fly" Technique for Transcatheter Tricuspid Valve Replacement in Failed Edge-to-Edge Repair.

BACKGROUND

Failed tricuspid edge-to-edge repair with recurrent symptoms poses a challenge for optimal management. We report the first case successfully treated with transcatheter tricuspid valve replacement using the EVOQUE system after transcatheter electrosurgery laceration of the septal leaflet.

CASE PRESENTATION: A 75-year-old woman was referred for recurrent severe tricuspid regurgitation after failed edge-to-edge repair due to early septal leaflet laceration after positioning of 2 devices. The heart team approved a percutaneous approach with advanced transcatheter techniques.

DISCUSSION: The electrosurgical laceration and stabilization of clip is a known tool to treat failed mitral repairs. This is the first report of a similar technique to treat recurrent tricuspid insufficiency after tricuspid edge-to-edge repair.

CONCLUSIONS

After failed tricuspid edge-to-edge repair, transcatheter electrosurgery can split the leaflet from the clip and allow effective implantation of a dedicated tricuspid valve replacement device.