Transcatheter Treatment of Severe Tricuspid Regurgitation with the Edge-to-Edge: MitraClip Technique
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 one or more MitraClip devices and reduction of TR by at least one grade, were evaluated before discharge and after 30 days. In addition, functional outcome, defined as changes in NYHA class and 6 minutes 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%. 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 one grade in 91% of the patients, thereof 4% that were reduced from massive to severe. In a total of 13% of patients TR remained severe after the procedure. Significant reductions in effective regurgitant orifice area (0.9±0.3cm2vs.0.4±0.2cm2; p<0.001), vena contracta width (1.1±0.5cm vs. 0.6±0.3cm; p=0.001) and regurgitant volume (57.2±12.8ml/beat vs. 30.8±6.9ml/beat; p<0.001) were observed. No intraprocedural deaths, cardiac tamponade, emergency surgery, stroke, myocardial infarction or major vascular complications occurred. There were 3 (5%) in-hospital deaths. NYHA class was significantly improved (p<0.001) and 6 minutes walking distance increased significantly (165.9±102.5m vs. 193.5±115.9m; p=0.007).
Conclusions—Transcatheter treatment of TR with the MitraClip system seems to be safe and feasible in this cohort of preselected patients. Initial efficacy analysis showed encouraging reduction of TR, which may potentially result in improved clinical outcomes.
- Received August 5, 2016.
- Revision received February 17, 2017.
- Accepted March 13, 2017.