Tricuspid valve repair with the MitraClip technique

Current surgical and medical treatment options for severe tricuspid regurgitation are extremely limited. However, this historically forgotten valve seems to have the option of transcatheter repair, nowadays.

This observational study assessed the safety and feasibility of the MitraClip system for patients with severe chronic tricuspid regurgitation.

All patients presented severe tricuspid regurgitation and symptomatic right heart failure despite optimal medical treatment.

Procedural safety assessed adverse events such as death, acute myocardial infarction, stroke, or cardiac tamponade. Feasibility was defined as successful implantation of one or more MitraClip devices and reduction of tricuspid regurgitation by at least one grade.

Results were evaluated before discharge and after 30 days, including a functional 6-minute walking distance test.

The study included 64 consecutive patients (mean age 76.6 ± 10 years) deemed unsuitable for surgery who received a MitraClip device for compassionate use. Functional tricuspid regurgitation was present in 88% of all cases. A third of all patients was also treated with the MitraClip system for mitral regurgitation.

The device was successfully implanted in 97% of the cases, and, after the procedure, regurgitation was reduced by at least one grade in 91% of the patients. In 4% of all cases, regurgitation was reduced from massive to severe.

Significant reductions in effective regurgitant orifice area (0.9 ± 0.3 cm² vs. 0.4 ± 0.2 cm²; p < 0.001), vena contracta width (1.1 ± 0.5 cm vs. 0.6 ± 0.3 cm; p = 0.001), and regurgitant volume (57.2 ± 12.8 mL/beat vs. 30.8 ± 6.9 mL/beat; p < 0.001) were observed.

No intraprocedural deaths, cardiac tamponade, emergency surgery, stroke, myocardial infarction, or major vascular complications occurred (there were 3 in-hospital deaths).

Functional class was significantly improved (p < 0.001) as was the outcome of the 6-minute walking distance test (165.9 ± 102.5 m vs. 193.5 ± 115.9 m; p = 0.007).

Conclusion

Transcatheter treatment of the tricuspid valve with the MitraClip system turned out to be safe and effective in this group of preselected patients. Initial efficacy as regards regurgitation reduction warrants further research.

Original title: Transcatheter Treatment of Severe Tricuspid Regurgitation with the Edge-to-Edge: MitraClip Technique.

Reference: Georg Nickenig et al.

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