Effects of TV Morphology on Transcatheter Tricuspid Valve Repair Outcomes

The researchers sought to describe tricuspid valve morphology and assess its impact on procedural results and clinical outcomes in edge-to-edge transcatheter tricuspid valve repair.

Transcatheter tricuspid valve repair (TTVr) procedures for patients with either a 3- or 4-leaflet configuration were found to be similarly successful. These findings were published as research correspondence in JACC Cardiovascular Interventions.

Patients (N=129) who underwent edge-to-edge TTVr for severe tricuspid regurgitation at the Heart Center Leipzig in Germany between 2016 and 2019 were retrospectively assessed. Commissures were determined in 30°-steps in the transgastric short-axis view, and leaflets were defined as a fold of tissue between 2 commissures. TTVr was successful if regurgitation was reduced at 30 days.

Patients had a 3-leaflet (64.3%), 4-leaflet (34.9%), or 2-leaflet (0.8%) morphology. The sole patient with a 2-leaflet morphology was excluded from further analysis.

Most patients with 3-leaflet and 4-leaflet morphologies had functional tricuspid regurgitation (92% vs 93%). The anteroseptal commissure was located at 150° among 70% and 69% or at 120° among 17% and 31%, respectively.

The maximum posteroseptal commissure was at 0° among 46% of the 3-leaflet group and at 30° among 58% of the 4-leaflet cohort. The anteroposterior commissure was at 240° (52%) and anteromural commissure between 210° and 240° (47%).

Among the patients with a 4-leaflet morphology, the posteromural commissure was at 330° (53%).

Patients in the 4-leaflet cohort were more likely to have a coaptation gap >7 mm (22% vs 8.5%; P =.035) and tended to have larger coaptation gaps (median, 4.5 vs 4.0 mm; P =.077) and larger right ventricular-mid diameters (mean, 44.9 vs 43.0 mm; P =.18).

Technical success was observed among 87% of the 4-leaflet and 94% of the 3-leaflet morphologies (P =.19). The failed procedures among patients with 3-leaflet morphology were determined to be due to lack of optimal leaflet grasping (n=2), leaflet perforation (n=1), acute single leaflet detachment (n=1), and device embolization (n=1). The failed procedures for the 4-leaflet group were due to lack of optimal leaflet grasping (n=3), chordae-related complications (n=3), and Chiari network (n=1).

No intraprocedural deaths or emergency surgery occurred.

Although the 4-leaflet configuration was associated with increased chordae-related complications, TTVr rates of success were not significantly different on the basis of leaflet morphology.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.


Kitamura M, Kresoja KP, Besler C, et al. Impact of tricuspid valve morphology on clinical outcomes after transcatheter edge- to-edge repair. JACC Cardiovasc Interv. Published online May 19, 2021. doi:10.1016/j.jcin.2021.03.052