Tricuspid Transcatheter Edge-to-Edge Repair as a Bridge in Tricuspid Regurgitation Deemed Non-Candidate to Transcatheter Tricuspid Valve Replacement.

BACKGROUND

Torrential tricuspid regurgitation (TR) in inoperable patients remains a major therapeutic challenge. Transcatheter tricuspid valve replacement (TTVR) is emerging as a definitive option, but many patients fail anatomical screening.

AIMS: To assess through a clinical case the feasibility of transcatheter edge-to-edge repair (TEER) as potential strategy to transform a patient deemed non-candidate to TTVR into a good candidate.

METHODS

We report how a 79-year-old man with torrential TR, chronic kidney disease, permanent atrial fibrillation, prior surgical aortic valve replacement, and a dual-chamber pacemaker who was rejected for TTVR after comprehensive screeningdue to large tricuspid annulus became good candidate to TTVR after TEER.

RESULTS

TEER was performed with implantation of two devices and initial symptomatic and hemodynamic improvement. Three weeks later, the patient deteriorated, and detachment of one of the devices from the lateral leaflet was demonstrated with recurrent massive TR. TTVR could be performed thanks to the reduction of the neo-annular size and the anchor in the failing TEER device. This case illustrates both the limits of TEER in end-stage TR and the conceptual role of TEER as a temporizing or remodeling strategy that may, in selected patients, reshape leaflet coaptation and annular geometry sufficiently to enable subsequent TTVR.

CONCLUSIONS

TEER may serve as a bridge-to-TTVR in anatomically marginal candidates, stabilizing patients clinically and modifying valve geometry to meet device-specific criteria. Prospective evaluation is warranted to define which anatomical substrates can benefit from this staged strategy.