'Zipping technique' for massive tricuspid leaflet flail-pushing the boundaries of transcatheter tricuspid valve repair: a case report.

Background: Tricuspid transcatheter edge-to-edge repair (T-TEER) has been shown to be a safe and effective therapy for patients with tricuspid regurgitation (TR). However, the success of the procedure is heavily influenced by tricuspid valve anatomy, with large flail gaps and wide coaptation gaps presenting significant technical challenges. Case summary: A 67-year-old man presented with symptomatic torrential TR from a flail anterior tricuspid leaflet. The huge flail gap was addressed with T-TEER using the 'zipping' technique by first grasping at a location away but near the intended pathology to facilitate leaflet approximation for grasping at the desired location. He had a successful procedure with final mild TR. Discussion: With increased operator experience and imaging expertise, coupled with device enhancements, the anatomical boundaries of T-TEER can be pushed. The 'zipping' technique, originating from mitral TEER, can be applied in T-TEER to treat large flail gaps or wide coaptation gaps that might have previously been considered unsuitable.