Introduction: Tricuspid regurgitation (TR) is a prevalent valvular heart disease associated with an increasing morbidity and mortality according to TR severity grade. Here, we report a comparison of procedural characteristics and learning curves of new interventional TR therapies: percutaneous annuloplasty and edge-to-edge repair (T-TEER). 

Methods: The present retrospective study was designed to analyze patients with severe to torrential TR undergoing interventional therapy from 2019 to 2022. Treatment comprised percutaneous annuloplasty (Cardioband, Edwards Lifesciences, Irvine, CA, USA) and T-TEER (TriClip, Abbott, Chicago, Illinois, USA, or PASCAL, Edwards Lifesciences, Irvine, Kalifornien, USA) in line with the decision of our local heart team. The appropriate device was selected according to the individual tricuspid anatomy and function by experienced interventionalists. Technical success was defined by Valve Academic Research Consortium (VARC) 3 criteria. 

Results: A total of 86 TR patients were treated with Cardioband (n=45) or T-TEER (n=41), which was technically successful in 91% and 98% of cases, respectively. In the Cardioband group, three injuries of the right coronary artery (narrowing or perforations) were treated by percutaneous coronary intervention. Another patient developed asystole requiring short-term cardiopulmonary resuscitation, possibly due to pressure on the atrioventricular node during implantation. In the T-TEER group, one single leaflet detachment occurred, resulting in a second intervention to stabilise the device. Procedure times were significantly shorter in the T-TEER group compared to the Cardioband group (93 [66-120] min vs. 160 [143-227] min, p<0.001). During the course of the study, the Cardioband group showed a significant decrease in procedure time, which was not observed in the T-TEER group (Cardioband: 249 [204-321] min for the first ten patients vs. 157 [131-178] min for the last ten patients, p=0.003; T-TEER: 97 [80-120] min for the first ten patients vs. 73 [55-113] min for the last ten patients, p=0.200). TR reduction of at least one grade was achieved in 100% of patients. The mean improvement of TR severity grade was 2.4±0.8 after Cardioband and 2.5±0.9 after T-TEER. In the T-TEER group, 1.9±0.5 devices per patient were used on average, predominantly between in the anteroseptal and posteroseptal commissures. Over the study period, we observed a trend towards a greater improvement in TR severity after T-TEER. However, the difference in TR grade improvement between the first and last ten procedures of each group was not statistically significant.

Conclusion: Both interventional therapies showed comparable technical success and resulted in a mean TR severity reduction of two grades when used in the appropriate tricuspid anatomy and function. Our data suggest that the learning curve results in shorter procedure times in percutaneous annuloplasties and a trend for better TR reduction in T-TEER over time.