The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Percutaneous edge-to-edge transcatheter tricuspid regurgitation repair: A single israeli center case series

Doron Sudarsky 1,2 Fabio Kusniec 1,2 Ala Lubovich 1,2 Liza Grosman-Rimon 1,2 Wadia Kinany 1,2 Evgeny Hazanov 1,2 Michael Gelbstein 1,2 Edo Y Birati 1,2 Shemy Carasso 1,2
1Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Israel
2The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Israel

Introduction

Transcatheter edge-to-edge tricuspid valve repair (TTVr) is an attractive treatment option for severe tricuspid regurgitation (TR) demonstrating, its feasibility, safety and effectiveness. Herein we report our preliminary experience with TTVr.

Materials and Methods

All procedures were performed using the Mitraclip® device using adopted technique.

Results and discussion

From July 2018 to march 2021, thirteen patients have undergone TTVr at Poriya medical center. Mean age was 72.9 ± 8.9 years; Five were female. Mean Euro-SCORE II was 12.5 ± 8.6%. Ten patients had New York Heart Association (NYHA) class ≥3. All suffered from TR≥4+. Ten patients had TR originating from antero-septal mal-coaptation and of them three had also postero-septal or TV center jets. In three cases TR rose solely from a postero-septal mal-coaptation.

Two patients underwent TV repair only while the rest had combined mitral and tricuspid valves (MV) repair. Successful TTVr was achieved in 12 patients (92.3%). Poor visualization of the TV prevented appropriate positioning of the device in one case, and septal leaflet detachment was seen after antero-septal deployment in another. A second clip was deployed next to it with stabilization. In one of the combined TMVr +TTVr cases a massive right to left shunt appeared after retraction of the delivery system, necessitating implantation of an ASD occluding device before treating the TV. TR severity was reduced by at least one level in all successful cases. There were no procedure-related complications.

Follow-up time ranged from 1 to 28 months (mean 6.9 ± 6.8 months). During this period one patient with failed TTVr died after 3 months from heart failure complications. Another patient died after 13 months from a non-cardiac related cause. All remaining patients are alive and experiencing improvement of heart failure symptoms and functional capacity.

Conclusion

Edge-to-edge TTVr is highly feasible and associated with improved patient symptoms.









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