Professor Liu Zhanwen's Cardiology Team from the Third People's Hospital of Xinjiang Uygur Autonomous Region has pioneered the novel K-Clip® transcatheter tricuspid annuloplasty technique!
Recently, the team led by Professor Liu Zhanwen from the Third People's Hospital of Xinjiang Uygur Autonomous Region has successfully delivered precise treatment to a patient with severe complex tricuspid regurgitation using the K-Clip® transcatheter tricuspid annuloplasty system. Marking the first breakthrough case in the Department of Cardiology at the hospital, the procedure has evidenced the team’s seamless collaboration as well as the safety and reliability of this surgical approach. It boosts local patients’ confidence in tackling refractory tricuspid valve diseases and further consolidates the development of transcatheter tricuspid valve diagnosis and treatment in Xinjiang.
Case Characteristics
The patient presented with mild tricuspid annular dilatation and marked right atrial enlargement, complicated by functional atrial tricuspid regurgitation graded 5+. The patient had prominent systemic circulatory symptoms with rapid disease progression and progressive deterioration of right ventricular function, showing poor response to oral medication. The patient had a prior history of pulmonary hypertension, which improved substantially after oral pharmacotherapy, rendering this a clinically complex case.
Intraoperative Images
Brief Introduction of Patient's Condition
The patient is an 83-year-old elderly female. She complained of palpitations of unknown cause over the past two months, with each episode lasting approximately 3 to 5 minutes and partial relief after rest. She was admitted to the Department of Cardiology of this hospital in March 2026 and diagnosed with severe tricuspid regurgitation, acute exacerbation of chronic cardiac insufficiency (NYHA Class III), second-degree type II atrioventricular block, and atrial flutter. Transcatheter tricuspid annuloplasty was recommended. Pharmacotherapy included rivaroxaban 15 mg once daily, atorvastatin calcium 20 mg once nightly, spironolactone 20 mg once daily and furosemide 20 mg once daily. Persistent discomfort remained despite regular medication, and she was readmitted to the Department of Cardiology for further management under the primary diagnosis of tricuspid regurgitation. In 2023, the patient received three months of targeted medical therapy for moderate pulmonary hypertension; pulmonary artery CTA performed at an outside hospital the same year showed unremarkable findings. Repeat testing on current admission revealed mild pulmonary hypertension with normal pulmonary artery architecture.
Preoperative Assessment
Echocardiography: Severe tricuspid regurgitation (4~5+ grade, average vena contracta width: 13 mm), with regurgitant orifices located at the anteroseptal, central and posteroseptal segments. No significant tricuspid annular dilatation was noted (mean annular diameter: 37 mm). Pulmonary artery systolic pressure: 34 mmHg. No obvious leaflet tethering was observed in all tricuspid leaflets.
Regurgitation at the right ventricular inflow and outflow tract on TEE
Central regurgitation demonstrated on TEE X‑Plane view
CTA assessment: Diastolic tricuspid annular circumference = 146 mm, annular area = 1647 mm². The right coronary artery (RCA) courses along the annular plane; the minimum diastolic distance between the RCA and tricuspid annulus measures 3.06 mm, indicating low risk of coronary artery injury during the procedure.
Surgical Strategy and Procedural Details
Combining the patient’s anatomical features, lesion severity as well as findings from CTA and echocardiography, the team led by Professor Liu Zhanwen formulated an individualized treatment regimen for the patient:
Based on annular morphology and the location of regurgitant orifices, a two-K‑Clip® clamping strategy was adopted:
Anchor Site 1: 5:30 position on tricuspid short-axis view, Clip model: 14T
Anchor Site 2: 8:30 position on tricuspid short-axis view, Clip model: 14T
Pre-procedural simulation predicted tricuspid regurgitation reduction to grade 2~3+.
Procedural Process
1.Vascular access via the internal jugular vein was established with a 6F sheath. After placement of the guidewire, the 6F sheath was exchanged for an 18F delivery sheath, which was secured to the operating table with a sterile stent holder. The large-bore sheath was advanced to the middle-to-inferior one-third of the right atrium.
2.The posteroseptal commissure was localized under 3D mode of transesophageal echocardiography (TEE).
The delivery sheath was advanced to the target site under three-dimensional visualization
3.The trajectory was adjusted under MultiVue view, followed by deployment of the anchoring screw and completion of traction test.
The MultiVue view was oriented toward the target for annular anchoring
4. The clip arms were opened and orientation adjusted under 3D imaging mode.
The clip arms were deployed and the orientation adjusted under three-dimensional guidance
5. The device was apposed against the tricuspid annulus under MultiVue guidance, and the first clip was deployed with combined DSA fluoroscopy
The device is apposed to the annulus under MultiVue guidance, and clip deployment is completed with DSA assistance
The first clip was deployed with DSA assistance
Implantation Procedure of the Second K-Clip® at the anteroposterior commissure:
The second clip was anchored and deployed at the annular site of the anterior-posterior leaflet commissure following the identical procedural steps.
The second clip was aligned to the anteroposterior commissure under three-dimensional guidance
The second clip achieved annular anchoring under MultiVue guidance
The clip arms of the second device were opened under three-dimensional imaging guidance
Orientation of the second clip was adjusted under three-dimensional guidance
The second clip was apposed to the annulus under MultiVue guidance
The second clip was apposed to the annulus under MultiVue guidance, with clip deployment completed aided by DSA
Post-procedurally, DSA was used to evaluate the overall configuration and positioning of all implanted clips
Deployment of the second clip was accomplished with DSA assistance
Postoperative Outcomes
Comparison of pre-procedural and post-procedural regurgitation
Pre-procedural regurgitant jet
Post-procedural regurgitant jet
Immediate echocardiographic assessment: Tricuspid regurgitation was reduced from grade 5+ pre-procedurally to grade 2+, the annular area decreased to 8.0 cm², and leaflet coaptation was satisfactory
Pre-procedural annular area: 13.3 cm²
Post-procedural annular area: 8.49 cm²
Summary
The Department of Cardiology at the Third People's Hospital of Xinjiang Uygur Autonomous Region has successfully performed the hospital’s first transcatheter tricuspid annuloplasty with the K‑Clip® system. This procedure marks a new breakthrough for the department in the interventional diagnosis and treatment of structural heart disease. The surgery proceeded smoothly with seamless interdisciplinary coordination throughout the entire process, demonstrating the department’s robust proficiency in interventional cardiology and comprehensive patient management capabilities. Based in Urumqi, the cardiology team consistently adheres to the core mission of delivering patient-centered care. By continuously overcoming barriers in conventional therapeutic approaches, the team safeguards local residents’ cardiac health with refined clinical expertise and fulfills its commitment to localized management of structural valvular heart disease.
Expert Introduction
Liu Zhanwen
The Third People's Hospital of Xinjiang Uygur Autonomous Region
Li Jin Yilong
The Third People's Hospital of Xinjiang Uygur Autonomous Region）
K-Clip® Transcatheter Tricuspid Annuloplasty System:
1.Vascular puncture approach with minimal trauma and an 18Fr outer diameter sheath.
2.Simple operation, all procedures completed at the atrial surface, with a short learning curve.
3.All procedural steps are reversible before detachment, enabling controllable surgical outcomes.
4.Physiological annuloplasty technology that preserves the native valve leaflets without damage.
