Continuous Hemodynamic Monitoring During Transcatheter Tricuspid Valve Repair: Insights From Pulse Contour-based Assessment

OBJECTIVES: This exploratory pilot study was designed to evaluate the effectiveness of pulse contour analysis (PCA) for real-time hemodynamic monitoring in patients undergoing transcatheter edge-to-edge tricuspid valve repair (T-TEER). Additionally, it examined whether continuous PCA monitoring can identify indicators of procedural success and improve perioperative management. DESIGN: Prospective, hypothesis-generating pilot, single-center study. SETTING: Single tertiary care university hospital. PARTICIPANTS: A total of 12 patients undergoing T-TEER. INTERVENTIONS: Real-time PCA was used throughout the intervention period, from preoperative assessment up to 4 hours postprocedure, to monitor hemodynamic parameters (cardiac output [CO], cardiac index [CI], stroke volume, stroke volume variation, and blood pressure). MEASUREMENTS AND MAIN RESULTS: At 4 hours after T-TEER, CO-PCA had increased by 30% (p = 0.0124), accompanied by a 0.68-L/min/m² rise in CI (p = 0.008). T-TEER also resulted in a persistent reduction in stroke volume variation-PCA, with a sustained 3% decrease after the intervention (p = 0.009). Implantation of the first device triggered a notable peri-interventional increase in systolic arterial pressure of 17 mmHg (p = 0.026). In addition, the right atrial v-wave decreased by 8 mmHg (p = 0.034). No meaningful changes in central venous oxygen saturation or central venous pressure were detected during or following the procedure (p = 0.73 and p = 0.27, respectively). CONCLUSIONS: This study demonstrated that PCA using FloTrack monitoring can provide valuable continuous hemodynamic information and characterize acute hemodynamic responses to T-TEER. PCA detected meaningful hemodynamic improvements during T-TEER, characterized by increased CO, enhanced CI, and more stable preload conditions.