The use of transcatheter tricuspid edge-to-edge repair (TEER) is growing steadily due to its minimally invasive nature. The VeriSight Pro 3D intracardiac echocardiography (ICE) catheter might help to increase procedural safety and improve procedural outcomes.

In this prospective, single-center, observational study, we compared the procedural outcomes of tricuspid TEER guided by ICE plus transesophageal echocardiography (TEE) or by TEE alone. Lead-induced tricuspid regurgitation and combined mitral–tricuspid procedures were excluded. Primary events were those associated with procedural and early (30-day) safety.

A total of 45 consecutive patients were included (25 guided by TEE and 20 by ICE+TEE). There were no significant differences in baseline clinical and echocardiographic features. No mortality, stroke, major bleeding, or major vascular events occurred. ICE significantly decreased the fluoroscopy time (ICE+TEE vs TEE: 16.2 [8.9-26.0] minutes vs 26 [18.2-32.0] minutes; P=.003), radiation dose (ICE+TEE vs TEE: 782 [390-1040] mGy vs 1413 [960-1705] mGy; P=.002), and dose–area product (ICE+TEE vs TEE: 5855 [2675-9328] cGy cm2 vs 12 120 [8670-15 080] cGy cm2; P=.004). Procedural time was also significantly decreased (ICE+TEE vs TEE: 55 [37-62] minutes vs 72 [50-80] minutes; P=.03). Optimal visualization of leaflet grasping and insertion was achieved in all ICE procedures.

The addition of 3D ICE guidance to TEE during tricuspid TEER is associated with lower fluoroscopy time and radiation exposure compared with TEE, without any significant disadvantages regarding procedural safety. This study represents the first national experience with the novel VeriSight Pro 3D ICE catheter.