Ex Vivo Assessment of Transcatheter Edge-to-Edge Treatment Performance After Pathology Recurrence in Functional Tricuspid Regurgitation

Functional tricuspid regurgitation (FTR) is closely associated with right ventricular (RV) dysfunction and pulmonary hypertension (PH), both of which contribute to increased morbidity and mortality in patients undergoing tricuspid valve repair or replacement. The biomechanical interplay between these factors remains complex, with conflicting evidence on the effects of edge-to-edge repair (TEER) on RV morphology and function. This study aimed to assess the acute impact of increased pulmonary pressure and RV dilation on TEER performance using an ex vivo pulsatile flow mock loop. A custom-designed clip, replicating state-of-the-art TEER devices, was tested on porcine heart samples under simulated FTR conditions with varying degrees of RV dilation and PH.

Results demonstrated that the clip significantly improved valve coaptation, increasing transvalvular systolic pressure and reducing regurgitant flow. However, elevated PH and severe RV dilation compromised its effectiveness, leading to increased regurgitation and a higher risk of pathology recurrence. Statistical analysis identified PH as the primary driver of hemodynamic deterioration, whereas RV dilation predominantly influenced annular morphology. These findings suggest that while TEER provides initial hemodynamic benefits, its efficacy may be limited in advanced FTR cases with progressive RV dysfunction and PH. Further research is needed to evaluate long-term outcomes. Nonetheless, this ex vivo approach allowed for the isolation of key biomechanical mechanisms, offering valuable insights into the structural and functional relationships underlying disease progression.