Background: Tricuspid regurgitation (TR) and right ventricular (RV) dysfunction have been identified as significant predictors of outcome after mitral valve surgery. Notably, mitral valve surgery tends to worsen TR and RV parameters. However, the impact of percutaneous mitral valve repair (PMVR) with the MitraClip system in TR and RV parameters has not been investigated yet. Methods: We retrospectively assessed TR and RV function parameters on baseline and follow-up (3-12 months after PMVR) transthoracic echocardiography of 60 consecutive patients (mean age 72+/-11 years, male gender 65.6%) with functional (57.4%), degenerative (32.8%), or mixed (9.8%) mitral regurgitation (MR), who underwent PMVR using the MitraClip system. TR was graded on a scale from 1 to 3 according to recommendations of the American Society of Echocardiography. RV function was analyzed using the fractional area change (FAC) and tricuspid anular plane systolic excursion (TAPSE). Results: Acute procedural success of PVMR was achieved in 56 (93%) patients. Baseline TR was grade 1 in 23 (38%), grade 2 in 18 (30%), and grade 3 in 19 (32%) patients. TR change (by at least one grade) after PMVR was as follows: decrease in 20 (33%) and increase in 7 (12%) patients (p=0.039). Systolic RV function (pre/post FAC and TAPSE) did not change significantly. The tricuspid annular diameter also remained unchanged. There was a trend toward a decrease in maximum pressure gradient across the tricuspid valve (36 mmHg versus 33 mmHg, p=0.14) which was poorly correlated with improvement in TR severity (OR 1.07; p=0.018). These findings were accompanied by a significant improvement of NYHA functional class (p< 0.01). Conclusions: In patients with severe MR, PMVR using the MitraClip device improves TR. Reduction of TR is associated with the improvement of symptomatic status after PMVR. A transcatheter TR solution is required for those patients who experience worsening of TR despite improvement of MR.
Frangieh, A. H., Gruner, C., Mikulicic, F., Tanner, F., Corti, R., Grünenfelder, J., … Gaemperli, O. (2014). TCT-790 Impact of Percutaneous Mitral Valve Repair on Tricuspid Regurgitation. Journal of the American College of Cardiology, 64(11), B231. https://doi.org/10.1016/j.jacc.2014.07.864