Intraprocedural Embolization of a Tricuspid Edge-to-Edge Repair Device and Its Percutaneous Retrieval: A Case Report

Background and Clinical Significance: Tricuspid transcatheter edge-to-edge repair (T-TEER) is an established therapy for severe tricuspid regurgitation (TR) in selected patients. Single-leaflet device attachment (SLDA) is the commonest device-related complication, but complete intraprocedural detachment with embolization is rare, and percutaneous retrieval of an embolized tricuspid device has been reported only exceptionally. Case Presentation: An inoperable elderly patient with previous transcatheter aortic valve implantation (TAVI) and torrential functional TR underwent T-TEER. After implantation of the first clip at the anteroseptal commissure with apparently adequate leaflet capture, anterior SLDA was identified and progressed to complete detachment and right atrial embolization of the device. Despite this, the T-TEER was completed by successful implantation of the second clip, leaving only mild residual central TR. In the same session, the embolized device was retrieved percutaneously from the femoral venous system using a 15 mm gooseneck snare advanced through a 22 Fr sheath, with a safety wire and en-bloc removal, without forcing ensheathing and without venous injury. The patient was discharged on post-procedure day 2 with durable TR reduction and clinical improvement. Conclusions: Complete leaflet detachment is a possible complication of T-TEER. Confirming deep, symmetric insertion in multiple echocardiographic windows before every release is essential. When embolization occurs, knowledge of device dimensions and immediate availability of a complete snare kit is important. Although this approach may be considered in selected patients, particularly those at high surgical risk, the available evidence is limited to isolated case reports and does not allow general conclusions on its safety or efficacy.