Transcatheter Treatment of Severe Tricuspid Regurgitation With the Edge-to-Edge MitraClip Technique

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-05, Vol.135 (19), p.1802-1814
• Main Authors: Nickenig, Georg, Kowalski, Marek, Hausleiter, Jörg, Braun, Daniel, Schofer, Joachim, Yzeiraj, Ermela, Rudolph, Volker, Friedrichs, Kai, Maisano, Francesco, Taramasso, Maurizio, Fam, Neil, Bianchi, Giovanni, Bedogni, Francesco, Denti, Paolo, Alfieri, Ottavio, Latib, Azeem, Colombo, Antonio, Hammerstingl, Christoph, Schueler, Robert
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac Catheterization - methods; Cohort Studies; Echocardiography, Transesophageal - methods; Female; Follow-Up Studies; Humans; Male; Severity of Illness Index; Surgical Instruments - statistics & numerical data; Treatment Outcome; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - therapy
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.116.024848

BACKGROUND:Current surgical and medical treatment options for severe tricuspid regurgitation (TR) are limited, and additional interventional approaches are required. In the present observational study, the safety and feasibility of transcatheter repair of chronic severe TR with the MitraClip system were evaluated. In addition, the effects on clinical symptoms were assessed. METHODS:Patients with heart failure symptoms and severe TR on optimal medical treatment were treated with the MitraClip system. Safety, defined as periprocedural adverse events such as death, myocardial infarction, stroke, or cardiac tamponade, and feasibility, defined as successful implantation of 1 or more MitraClip devices and reduction of TR by at least 1 grade, were evaluated before discharge and after 30 days. In addition, functional outcome, defined as changes in New York Heart Assocation class and 6-minute walking distance, were assessed. RESULTS:We included 64 consecutive patients (mean age 76.6±10 years) deemed unsuitable for surgery who underwent MitraClip treatment for chronic, severe TR for compassionate use. Functional TR was present in 88%; in addition, 22 patients were also treated with the MitraClip system for mitral regurgitation as a combined procedure. The degree of TR was severe or massive in 88% of patients before the procedure. The MitraClip device was successfully implanted in the tricuspid valve in 97% of the cases. After the procedure, TR was reduced by at least 1 grade in 91% of the patients, thereof 4% that were reduced from massive to severe. In 13% of patients, TR remained severe after the procedure. Significant reductions in effective regurgitant orifice area (0.9±0.3cm versus 0.4±0.2cm; P