Tricuspid annulus remodelling after transcatheter edge-to-edge repair for reduction of tricuspid regurgitation

Background In the last years multiple transcatheter devices for tricuspid valve interventions were developed. Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device (TriClip Abbott Vascular, Santa Clara, CA, USA) for reduction of tricuspid regurgitation. Methods and results This is a retrospective dual-center cohort study that includes 26 consecutive patients, treated with TriClip in Maria Cecilia Hospital of Cotignola and in the University Hospital of Verona. Tricuspid annulus geometry was evaluated using three-dimensional transesophageal echocardiography examinations conducted during the procedure before and after TriClip implantation. The mean age of the study cohort was 79,3 years, and 88,5% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,44 cm vs 3,54 ± 0,53 cm, p=< 0,0001), mean major diameter (4,65 ± 0,63 cm vs 4,28 ± 0,65 cm, p=0,0002), planimetric area (14,00 ± 2,91 cm2 vs 11,25 ± 2,91 cm2, p=<0,0001) and perimeter (13,62 ± 1,43 cm vs 12,42 ± 1,62 cm, p=<0,0001) of the tricuspid annulus was observed. Conclusions In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to reduction in the tricuspid annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Maria Cecilia Hospital gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.