Transcatheter Tricuspid Valve Edge-to-Edge Repair in a Patient Following Heart Transplantation

BACKGROUND: Transcatheter tricuspid valve edge-to-edge repair (T-TEER) is an emerging therapy for severe tricuspid regurgitation (TR), but experience in heart transplant recipients is limited. CASE SUMMARY: A 42-year-old man, 1-year post heart transplantation, presented with severe volume overload and dyspnea. Echocardiography confirmed severe TR with a flail posterior leaflet. Given high surgical risk, he underwent T-TEER with TriClip (Abbott), reducing TR to moderate with resolution of hepatic vein systolic flow reversal. Later, recurrent hypervolemia from missed dialysis led to TR progression. After kidney transplantation, imaging demonstrated stable clip positioning with moderate residual TR. DISCUSSION: Severe TR affects nearly 20% of heart transplant recipients and predicts mortality and retransplantation. Early TR results from biopsy-related valve trauma, whereas late TR links to graft dysfunction and rejection. Surgical management carries high morbidity and failure rates. Percutaneous options like T-TEER are promising but require further validation. TAKE-HOME MESSAGE: T-TEER is feasible in heart transplant recipients and may bridge to eligibility for other lifesaving therapies.