TEER, or transcatheter edge to edge repair, is a minimally invasive catheter-based procedure that providers repair of a leaking valve. Tricuspid TEER repairs the tricuspid valve, which separates the top and bottom chambers on the right side of the heart. This procedure is recommended for patients who have severe, symptomatic tricuspid regurgitation. It is best suited for patients who would be high risk for surgical intervention and/or are not responding well to medical therapy.

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Prior to procedure

Before you undergo a transcatheter tricuspid valve repair there are several appointments and tests you may be scheduled for including:

• TEE or transesophageal echocardiogram
• Coronary angiogram
• Consultation with Interventional Cardiologist - prior to procedure you will need to meet with the structural heart/valve specialist to discuss the risks and benefits to this procedure. Interventional cardiologists are the providers who perform the transcatheter valve repairs.
• Heart Failure Specialist visit - in some cases the heart valve specialist who will perform your transcatheter tricuspid repair will recommend you meet with a heart failure specialist. Heart failure can be a contributing factor to this disease process and ensuring you are medically optimized and on the best medication regimen pre-procedure is crucial.
• Consultation with a Cardiothoracic Surgeon - even if transcatheter repair of your valve is recommended, it is still required that you meet with an open-heart surgeon. This provides you with all the available options and allows you to hear what your personal risk and benefit would be to surgically repairing or replacing your valve. It is also required by most insurance companies in order to move forward with your procedure.
• Dental clearance - a visit with your dentist is required to ensure you have no active infection or teeth that may become infected. If dental work is required, it is preferred to have this done prior to your procedure to decrease the risk of infection on your device or in the heart.
• Additional tests/appointments as needed - based on specifics of your case, comorbidities, etc. it may be recommended that you meet with additional specialists or have additional testing prior to undergoing transcatheter tricuspid valve repair.

Procedure overview

Once the work up process is complete and it is confirmed you are a good candidate for transcatheter tricuspid valve repair you can expect a 1–3-night stay in the hospital to complete your procedure. The procedure itself takes approximately 2 hours and is done under general anesthesia. During your procedure you will also have a TEE or transesophageal echocardiogram probe placed for imaging.

During the procedure a puncture is made in the large vein in your leg, your femoral vein. A catheter is threaded up to the heart with the device on the catheter. Xray technology and contrast dye, along with the TEE images allow the interventional cardiologist to guide the catheter and device into the correct location. The device functions like a clip to pull the leaflets of your valve together, ultimately decreasing the amount of leaking across the valve. You may have other large size catheters and IVs placed during your procedure.

Risk and Benefits

Benefits to this procedure include:

• Improved quality of life and symptom reduction
• Minimal interruption to lifestyle, short hospital stay and recovery time
• Decreased risk of further complications related to severe tricuspid regurgitation (heart failure)
• For many patients this is the only procedure they will require to treat their tricuspid valve

Risks of this procedure include:

• Bleeding anywhere from the insertion site of the catheter up to and including the structures of the heart
• Detachment of the device and/or recurrence of severe tricuspid regurgitation
• Valve damage which may complicate or prevent later surgical repair
• Cardiac arrhythmias (abnormal heart rhythms)
• General post procedure complications such as infection, blood clots in the legs or lungs, pain, nausea/vomiting, etc.

Recovery

Once cleared for discharge you will have several follow up appointments with your structural heart team to ensure you are recovering well and that your device is functioning properly. This includes both echocardiographic imaging and visits with your provider. You will have activity restrictions for less than one week following your procedure and can typically resume normal routines following that. All patients are encouraged to work with cardiac rehab following valve repair or replacement.