Efficacy and Safety of TriClip Procedure in Patients with Severe Tricuspid Regurgitation and Large Coaptation Gap

Abstract

Purpose: This study aimed to evaluate the safety and efficacy of transcatheter tricuspid valve repair using the TriClip system in patients with severe tricuspid regurgitation (TR) and large coaptation gaps (> 10 mm), a subgroup traditionally considered anatomically challenging for edge-to-edge repair. Methods: A retrospective analysis was conducted on 9 symptomatic patients who underwent TriClip implantation at multiple centers in Turkey between March 2024 and May 2025. All patients had severe or greater TR with coaptation gaps exceeding 10 mm and were deemed high-risk for surgical intervention. Clinical and echocardiographic parameters were collected before and after the procedure. Results: The mean age of patients was 68.4 ± 8.6 years. The average coaptation gap was 17.56 ± 3.43 mm. The procedure achieved 100% technical success, defined as at least a one-grade reduction in TR severity. The mean number of clips implanted was 3.22 ± 0.83, with the XTW clip used in 86.3% of cases. No major complications or in-hospital mortality occurred. Symptomatic improvement was observed in all patients, with most experiencing at least one New York Heart Association (NYHA) class reduction. Mean follow-up duration was 6.7 ± 2.4 months. Conclusion: TriClip repair appears to be a safe and effective therapeutic option in high-risk patients with severe TR and large coaptation gaps. Despite anatomical complexity, significant reductions in TR severity and clinical symptoms were achieved, with low complication rates. These findings support the feasibility of TriClip therapy in this challenging patient population. © 2025 Elsevier B.V., All rights reserved.