P3000Six-month results of transcatheter edge-to-edge repair of severe tricuspid regurgitation

Abstract

Purpose: The purpose of this study was to investigate the six-month clinical results of transcatheter tricuspid valve edge-to-edge repair in selected, highly symptomatic patients with severe tricuspid regurgitation (TR). Methods: 23 consecutive patients were treated for severe symptomatic TR using the edge-to-edge repair technique in 2016. All patients suffered from severe right sided heart failure (NYHA III-IV) primarily due to severe TR and were deemed inoperable by the heart team. In order to successfully implant the clips between tricuspid leaflets we developed a modified steering technique for the MitraClip® system via the right femoral vein to access the tricuspid valve. Transesophageal and transthoracic echocardiographies were used to guide the clip delivery system as well as to visualize leaflet grasping and leaflet insertion. Success of the interventional procedure was defined as reduction of at least one TR grade applying a 4-grade scale. Results: Treated patients (age: 78±7 yrs) were considered to be at high surgical risk (EuroScore II: 9.3±7.4%). Eight patients were treated for isolated severe TR, while 15 patients received an edge-to-edge repair of both the mitral and tricuspid valves. A total of 54 (2.3±0.7) clips were placed in the tricuspid valve. A successful procedure with TR reduction by one grade was achieved in all patients. The mean TR grade was reduced from 3.4±0.6 to 1.7±0.6 without relevant increase in tricuspid gradients. During in hospital stay, we did not observe any major complications. Six-month clinical follow-up was available in all patients (100%). During followup three patients died from progressive heart failure, two patients needed repeat tricuspid intervention (one patient suffered from both events). In the remaining 19 patients, the reduction of tricuspid regurgitation remained durable with a mean 6- month TR grade of 1.8±1.0. This reduction translated in a significant improvement in NYHA class (before the procedure:100% in class III or IV; at 6-month FU: 60% in class I or II). The 6-min walking distance improved from 218±117m to 296±91m (p=0.02; in 11 pts). Conclusion: Applying a modified steering technique, severe TR can be successfully treated percutaneously by the edge-to-edge repair technique. The achieved reduction in TR appears to be durable at 6 months, which translated into a significant improvement in heart failure symptoms. Further studies have to define the role of this novel treatment option for patients with isolated tricuspid or combined mitral and tricuspid regurgitation.