Tricuspid transcatheter edge-to-edge repair in local anaesthesia guided by three-dimensional intracardiac echocardiography: a case report

Tricuspid transcatheter edge-to-edge repair (T-TEER) effectively reduces tricuspid regurgitation (TR) severity and improves symptoms and functional outcome in patients with TR and high surgical risk. Procedural guidance using intracardiac echocardiography (ICE) is a promising alternative in case of impaired imaging quality or contraindications for transoesophageal echocardiography (TEE) but also to defer any form of anaesthesia. The present case report aims to display the feasibility of an ICE-only guided T-TEER procedure in local anaesthesia and respective set-up.

A multimorbid 74-year-old man with severe mixed secondary TR was admitted for elective T-TEER. He suffered from NYHA III dyspnoea, chronic lower leg oedema and had two heart failure hospitalizations in the last 14 months. Local heart team recommended T-TEER due to the high individual surgical risk. TR was successfully reduced to trace by ICE-only guided T-TEER with implantation of two devices, one in anteroseptal and one in posteroseptal position in conventional clover technique. The patient was discharged without any notable complications.

The present case report demonstrates the feasibility of an ICE-only guided T-TEER, exclusively conducted in local anaesthesia. High-quality intraprocedural imaging guidance was essential for achieving procedural success.