ArticleEuropean heart journal. Case reports2026
The TriArtic procedure: TRIcuspid annular reduction by TEER in the commissure-a transcatheter annuloplasty enabling EVOQUE tricuspid valve replacement: a case report.
Article in European heart journal. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Transcatheter tricuspid valve replacement (TTVR) with the EVOQUE system has expanded therapeutic options for severe tricuspid regurgitation (TR), but a prohibitively dilated tricuspid annulus may exceed the device-sizing matrix and preclude implantation. No transcatheter strategy has been described to mechanically pre-condition such an annulus. Case summary: A 71-year-old woman with heart failure with reduced ejection fraction (left ventricular ejection fraction 38%, suspected premature-ventricular-complex-induced cardiomyopathy), permanent atrial fibrillation, and class III obesity presented with torrential atrial functional TR refractory to fully optimized guideline-directed medical therapy. Screening cardiac computed tomography (CT) classified the native annulus as 'outside parameters' for the 56 mm EVOQUE (Edwards Lifesciences); the Heart Team also deemed standalone tricuspid edge-to-edge repair (T-TEER) inadequate owing to the massively dilated annulus. We performed the TriArtic procedure-a single TriClip XTW (Abbott) deployed in the septo-anterior position as a transcatheter annuloplasty step. Repeat CT after 27 days demonstrated an ∼11% reduction in tricuspid annular area and conversion of projected-derived-diameter oversizing from -2.9% to +3.3% (within parameters). Transfemoral EVOQUE 56 mm was implanted 48 days after the TriClip; postprocedural imaging confirmed no residual regurgitation and a mean transtricuspid gradient of 1 mm Hg, with rapid recovery of cardiorenal function. Discussion: Transcatheter tricuspid annuloplasty by a strategically placed commissural TEER device may convert a prohibitively dilated annulus into one within EVOQUE-implantable parameters. In carefully selected patients ineligible for either standalone strategy, sequential transcatheter annuloplasty followed by valve replacement-the TriArtic procedure-may offer a feasible pathway, conceptually analogous to the mitral ARCTIC technique. This single case demonstrates feasibility only and does not establish general applicability.
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