Transcatheter Tricuspid Annuloplasty in Tricuspid Regurgitation Patients With Right Ventricular-Pulmonary Arterial Uncoupling

BACKGROUND There is limited evidence regarding evidence of transcatheter tricuspid annuloplasty using K-Clip (Huihe Medical Technology) in tricuspid regurgitation (TR) patients with right ventricular-pulmonary arterial (RV-PA) uncoupling. OBJECTIVES This study sought to explore the role of transcatheter tricuspid annuloplasty in patients with RV-PA uncoupling. METHODS This was a retrospective observational study, including patients who underwent transcatheter annular repair successfully using the K-Clip device with RV-PA uncoupling at 9 centers in China. RV-PA uncoupling was characterized by a tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (PASP) ratio <0.55. Baseline information, imaging results, and their subsequent follow-up data were collected. RESULTS All 81 patients (29 men, 72.6 f 6.9 years of age) underwent successful intervention were enrolled in this study. During 30 days and 6 months follow-up, patients showed significant improvement in tricuspid annular plane systolic excursion/PASP rate (baseline vs 30 days: 0.40 f 0.07 vs 0.50 f 0.18; P < 0.001; baseline vs 6 months: 0.40 f 0.07 vs 0.44 f 0.11; P = 0.007) and decline in PASP comparing to those at baseline; patients with RV-PA uncoupling showed sustained improvement in TR status with significant improvement in life quality (NYHA functional class, Kansas City Cardiomyopathy Questionnaire scores); 3 noncardiovascular deaths were documented, and the rate of adverse events during follow-up was acceptable. CONCLUSIONS Transcatheter tricuspid annuloplasty showed a significant and durable improvement in TR in patients with RV-PA uncoupling. Significant improvement and decline are observed in RV-PA ratio and PASP, respectively. All-cause mortality and adverse event rates were acceptable, with sustained improvements in quality of life. (JACC Asia. 2025;5:424-433) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).