Tricuspid TEER — Advanced Procedural Strategies-Dr. Price Leaflet Grasping slides

Dr. Price Leaflet Grasping slides

Pdf Summary

This document provides detailed guidance on leaflet grasping techniques during transcatheter tricuspid valve repair (T-TEER) using a clip delivery system. Key procedural steps include establishing the clip system trajectory perpendicular to the tricuspid valve plane, typically in the mid/deep esophageal right ventricular (RV) inflow/outflow or live multiplanar reconstruction (MPR) views. Proper orientation is critical—the clip arms must be orthogonal to the leaflet coaptation plane, with the transgastric short-axis (TGSAX) echocardiographic view considered the gold standard for ensuring correct alignment.<br /><br />Clarification is given on how to manage the "septal hugger" phenomenon (when the clip trajectory is too septal) by using the “L” knob to adjust the guide catheter counter-clockwise, moving the clip posteriorly and laterally. Rotation of the steerable guide catheter (SGC) and manipulation of the clip delivery system (CDS) handle clockwise or counterclockwise helps fine-tune clip arm positioning relative to the anterior and septal leaflets.<br /><br />During leaflet grasping, operators should advance the clip open into the RV, confirm position and orientation, and minimize unnecessary clip rotation or flexion under the valve. Good leaflet insertion is characterized by minimal leaflet motion, leaflets draping over clip arms, a broad tissue bridge in TGSAX view, and a shortened free leaflet edge outside of the clip.<br /><br />If there is uncertainty about leaflet insertion, controlled gripper actuation can optimize leaflet capture by selectively raising and lowering individual grippers with careful handle and catheter adjustments. Confirming leaflet insertion in multiple echocardiographic views (RV inflow/outflow, 3D intracardiac echo, TGSAX, live MPR) is essential for procedural success.<br /><br />In summary, successful tricuspid leaflet grasping requires perpendicular clip trajectory, orthogonal clip arm orientation, use of steering knobs for position correction, and multimodal echocardiographic confirmation. Proper technique optimizes leaflet capture, minimizes complications like single leaflet device attachment, and improves repair durability.

Keywords

transcatheter tricuspid valve repair

T-TEER

tricuspid

leaflet grasping techniques

clip delivery system

clip trajectory alignment

transgastric short-axis view

septal hugger phenomenon

steerable guide catheter manipulation

echocardiographic confirmation

leaflet insertion optimization