ANTecedent Annular Reduction to Facilitate TransCatheter TrICuspid Valve Replacement (ANTARCTIC)

BACKGROUND: Transcatheter tricuspid valve implantation may not be possible when annular size is very large. CASE SUMMARY: We present an 85-year-old man who developed NYHA functional class III symptoms and recurrent heart failure hospitalizations due to severe tricuspid regurgitation and right ventricular dysfunction. Marked annular enlargement precluded primary transcatheter tricuspid valve replacement. Transcatheter edge-to-edge repair with a PASCAL device achieved partial tricuspid regurgitation reduction and annular remodeling. Follow-up imaging demonstrated reduced annular dimensions, enabling successful staged transcatheter tricuspid valve replacement with a 56-mm EVOQUE valve. DISCUSSION: Severe tricuspid regurgitation with right ventricular dysfunction and extreme annular enlargement is difficult to treat with existing transcatheter therapies. TAKE-HOME MESSAGES: Staged transcatheter edge-to-edge repair-facilitated transcatheter tricuspid valve replacement approach is feasible.