In this closing chapter of ICE and TEE Guidance for TriClip Tricuspid TEER, Dr Karim Al‑Azizi (Baylor Scott & White Health – The Heart Hospital, US) presents the final evaluation and outcomes of an 80‑year‑old woman with pacemaker‑associated tricuspid regurgitation successfully treated with a two‑device TriClip XTW repair. 

With one clip positioned anterior and the other posterior to the pacemaker lead, he reviews haemodynamic stability, confirms only mild residual regurgitation on echocardiography, and discusses access‑site closure and post‑procedural care—culminating in next‑day discharge and marked symptomatic improvement at 30 days.

Dr Al‑Azizi demonstrates how a streamlined hybrid imaging protocol and effective team communication can shorten procedure time to under 50 minutes while ensuring durable reduction of tricuspid regurgitation, preservation of right ventricular function, and meaningful improvement in quality of life (Kansas City Cardiomyopathy Questionnaire score: 42 to 78). This outcome‑focused summary offers valuable procedural and clinical benchmarks for interventional and imaging cardiologists managing complex lead‑related tricuspid valve disease.
 

Key learning points:

• Post‑implant residual tricuspid regurgitation assessment: Evaluating residual jets following two‑clip TriClip repair, confirming only mild regurgitation around the pacemaker lead with stable haemodynamics and transvalvular gradients.
• Procedural efficiency and access management: Applying coordinated hybrid imaging and venous‑access closure techniques to achieve sub‑60‑minute procedures, safe in‑lab extubation, and next‑day discharge in elderly, high‑risk patients.
• Clinical and echocardiographic follow‑up: Interpreting 30‑day transthoracic echocardiography results and correlating improvements in Kansas City Cardiomyopathy Questionnaire score, dyspnoea, and oedema to define procedural success in advanced tricuspid valve disease.