3D echocardiographic assessment of reverse remodelling of the tricuspid annulus after transcatheter edge-to-edge repair

Abstract Introduction Transcatheter edge-to-edge repair (T-TEER) with the TriClip system is known as an effective treatment of severe tricuspid regurgitation. However, the data is limited about the tricuspid annular remodelling caused by the T-TEER. Our study aims to evaluate the remodelling of the tricuspid valve annulus after the T-TEER by using 3D echocardiography. Methods and results We prospectively enrolled 22 consecutive symptomatic patients () with severe tricuspid regurgitation (TR), who underwent T-TEER with the TriClip System between February 2023 and March 2024. 3D dataset was acquired from the tricuspid valve annulus before the procedure, immediately after the procedure and at the 1-year follow-up visit. The following parameters were assessed off-line using the dedicated tricuspid valve analysis software: annulus area (AA), septal-lateral (SL) and antero-posterior (AP) annulus diameters in mid-systolic phase. Acute procedural success was achieved in 91% of cases. We observed a reduction in AA and the AP annulus diameter (AA from 13.6±4 cm2 to 10.6±3.1 cm2, p=0.01; AP diameter from 40.7±9.3 mm to 35.8±6.1 mm, p=0.003) immediately after the T-TEER, and the reduction remained at the 1-year follow-up examination (AA: 10.6±2.4 cm2, p=0.02; AP: 35±5.5 mm, p=0.007). However, the reduction due to the septal-lateral dimension was not significant at all timepoint (SL: 40.7±9.3 mm before intervention, 35.8±6 mm immediately after intervention, 36.7±4.5 mm at 1-year follow-up; p=0.056; p=0.23). The tricuspid valve (TV) annulus was larger in patients with higher residual TR. Conclusion The TV annulus reduction can be observed after TriClip implantation as an acut effect of the intervention, and the achieved remodelling remained even 1 year after the procedure. The antero-posterior diameter changed in the same way as annulus area, however the septo-lateral diameters did not.