Abstract
Introduction: Echocardiographical guiding gains further importance as transcatheter interventions for heart valve diseases advance. In transcatheter edge-to-edge repair for tricuspid regurgitation (TEER-TR), the use of transesophageal echocardiography (TEE) employing biplane imaging with views perpendicular to the inflow-outflow-view is suggested. However, robust data on echocardiographical guiding in this setting is lacking, as well as on the role of fluoroscopy settings. Hypothesis: The aim of the study was to evaluate different guiding-approaches and fluoroscopy settings in TEER-TR procedures. Methods: We retrospectively assessed the effect of different echocardiographical guiding strategies and fluoroscopy angulations on immediate TR reduction (ΔTR), and device time in the TEER-TR interventions. Echocardiographical guiding was rated using a new quality scoring system, MACES 3 . Results: From July 2016 to December 2019 a total of 190 cases of TEER-TR procedures were conducted. In all but 2, the procedure was successfully completed. Device deployment was achieved using transesophageal imaging in 65 cases (n[mid-esophageal]=47, (midE); n[deep-esophageal]=18, (deepE)), while live-MPR was employed 4 times. The transgastric en-face view (TG) constituted the grasping view 119 times (Fig. 1). The best imaging quality with the highest MACES 3 scores were observed in deepE and TG. MACES 3 scores significantly influenced the acute outcome. In cases of secondary TR, the use of TG was superior to other imaging in achieving a ΔTR of ≥ 2 grades. Both the use of TG and special fluoroscopy alignment significantly reduced the device time. Conclusions: TEER-TR can be effectively guided using different echocardiographic strategies. To strive for the best imaging quality clearly increases procedural success. Using the TG approach offers benefits in immediate procedural result and device time, with the latter further reduced using fluoroscopic alignment.
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