{
  "abstract": "Background\n\nTranscatheter 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\n\nA 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\n\nTranscatheter 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.",
    "Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, Germany."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Raphael Phinicarides",
      "orcid": "0000-0002-2831-8999"
    },
    {
      "affs": [
        0
      ],
      "name": "Fabian Voß",
      "orcid": "0000-0002-1098-9284"
    },
    {
      "affs": [
        0
      ],
      "name": "Tobias Zeus",
      "orcid": "0000-0002-4517-0068"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Amin Polzin",
      "orcid": "0000-0002-5891-9672"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9q6t9jr541tnf.bib",
  "cited_by": 0,
  "doi": "10.1093/ehjcr/ytag729",
  "fulltext_url": "https://europepmc.org/articles/PMC13678208",
  "id": "9q6t9jr541tnf",
  "issns": [
    "2514-2119"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898779",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Cardiac Valve Diseases and Treatments"
    ]
  ],
  "openalex": "W7220833852",
  "pdf_url": "https://europepmc.org/articles/PMC13678208?pdf=render",
  "pmcid": "PMC13678208",
  "pmid": "42898779",
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/9q6t9jr541tnf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "MED:42898779",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898779"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac Valve Diseases and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "The TriArtic procedure: TRIcuspid annular reduction by TEER in the commissure-a transcatheter annuloplasty enabling EVOQUE tricuspid valve replacement: a case report.",
  "title_text": "The TriArtic procedure: TRIcuspid annular reduction by TEER in the commissure-a transcatheter annuloplasty enabling EVOQUE tricuspid valve replacement: a case report.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/9q6t9jr541tnf",
  "venue": "European heart journal. Case reports",
  "versions": []
}