Off-Label Use of Septal Occluder Devices for Recurrent Tricuspid Regurgitation Following TEER

We report 4 high-risk patients with massive to torrential TR due to interclip coaptation defects who were treated with off-label percutaneous closure using septal occluder devices. Procedural strategy evolved from transfemoral to right internal jugular access to improve coaxial alignment and deployment control. Early atrial septal occluders embolized, whereas muscular ventricular septal defect occluders, with a broader waist, provided stable anchoring and durable TR reduction. Balloon test occlusion and meticulous intraprocedural imaging were essential to avoid iatrogenic tricuspid stenosis. Clinical outcomes ranged from sustained symptomatic improvement to persistent right heart failure in advanced disease. Together, these cases suggest that in anatomically selected patients, occluder implantation may represent a feasible salvage strategy for recurrent TR after TEER when established therapies are not possible.