Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Early experience, procedural characteristics and 6-months follow-up of symptomatic patients with high-grade tricuspid insufficiency undergoing transcatheter edge-to-edge-repair with the TriClip device
L. A. Kettler1, P. Nikolai1, S. Hill1, K. A. Storm2, H. Arndt1, N. Kugler1, H. Mahrholdt1, P. Ong1, R. Bekeredjian1
1Innere Medizin III / Kardiologie, Robert-Bosch-Krankenhaus, Stuttgart; 2Robert-Bosch-Krankenhaus, Stuttgart;

Background: Transcatheter edge-to-edge repair (TEER) on the tricuspid valve with the TriClip device has recently been approved for the use in human beings. Little is known about the efficacy, procedural characteristics and outcome in patients receiving this kind of treatment.

Objectives: To assess clinical and procedural characteristics as well as 6-month prognosis in symptomatic patients with high-grade tricuspid insufficiency undergoing TEER with the TriClip device.

Methods: Between 07/2020 and 07/2021 a total number of 74 patients with high-grade tricuspid insufficiency underwent TEER with the TriClip device. In all patients the following data were obtained (age, sex, clinical characteristics, NYHA class, EURO risk score and laboratory parameters). A subset of the patients (n=33) underwent a comprehensive study protocol including assessment of echocardiography, laboratory markers, NYHA class, CMR and MOCA/BIA tests pre and post TEER.

Results: The mean age of our study cohort was 80 years (±6), 38% were male. The mean NYHA class was 3.1 and the mean EURO Score II was 5.0. TEER with the TriClip device was successfully performed in all patients.

Our subgroup analysis (n=33) revealed that in the majority of procedures two clips were implanted. The first clip was implanted in the anteroseptal position (85% of cases) and the second was implanted mainly in the posteroseptal position (93% of cases). In those cases where a third clip was necessary this was implanted in the posteroseptal position.

Follow-Up after 6 months showed that a significant median TR reduction from grade 3 to 2 was observed (p<0.0005). Moreover the median NYHA class was reduced from 3 to 2 (p<0.0005). In addition, significant improvements in the total KCCQ Score, the albumin concentrations and the MOCA-testing were observed. Two patients passed away during follow-up corresponding to a mortality rate of 6.1%.

Conclusions: TEER is a new, safe and effective treatment option for symptomatic patients with high-grade tricuspid insufficiency with a favourable 6-month outcome. More studies are needed to better define the patient cohort that benefits most from this treatment.