# The edge-to-edge repair of the iatrogenic torrential tricuspid regurgitation complicating transvenous pacemaker lead extraction: a case series

## TL;DR

This case series explores using transcatheter tricuspid edge-to-edge repair to treat severe tricuspid regurgitation caused by pacemaker lead extraction in patients unsuitable for surgery.

## Contribution

Demonstrates the feasibility of transcatheter repair for iatrogenic tricuspid regurgitation in high-risk patients.

## Key findings

- Transcatheter tricuspid edge-to-edge repair successfully treated tricuspid regurgitation in three out of four cases.
- Accurate assessment of regurgitation mechanism is crucial for successful transcatheter repair.
- Image quality limitations can hinder identification of the regurgitation cause in some cases.

## Abstract

New tricuspid regurgitation (TR) or worsening of baseline pathology may appear after transvenous pacemaker lead extraction (TLE). In case of severe TR induced by TLE, surgical correction might be required. However, the patients in whom TLE is performed are not always appropriate candidates for open-heart intervention.

Herein, we present four patients with iatrogenic TR significantly increased to severe-torrential grade after TLE, who were disqualified from surgery. In three cases, the regurgitation was associated with an avulsion of the papillary muscles or chordae tendineae. In one case, it was likely due to the perforation of the tricuspid leaflet during TLE. Patients were treated with transcatheter tricuspid edge-to-edge repair (T-TEER), in three cases successfully.

Percutaneous repair of TLE-related TR is feasible and may be a valuable therapeutic option in patients with prohibitive surgical risk. One of the most important factors leading to a T-TEER procedural success is the accurate assessment of the tricuspid regurgitation mechanism. In the fourth case, identification of the underlying regurgitation cause was limited by the image quality in the transoesophageal examination.