Institutional learning experience for combined edge-to-edge tricuspid and mitral valve repair

Madeline K. Mahowald, Sorin V. Pislaru, Guy S. Reeder, Ratnasari Padang, Hector I. Michelena, Sunil V. Mankad, Joseph F. Maalouf, Mayra Guerrero, Mohamad Alkhouli, Charanjit S. Rihal, Mackram F. Eleid

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Transcatheter edge-to-edge repair with MitraClip is only approved for treatment of mitral regurgitation but is increasingly used to treat concomitant tricuspid regurgitation (TR) due to its common coexistence and association with poor outcomes. This study aimed to describe the learning curve associated with the challenge of off-label treatment of concomitant TR. Methods: This is a retrospective review of initial and consecutive patients who underwent combined edge-to-edge repair of mitral and tricuspid valves (TVs) at our institution from August 2017 to October 2019. Results: Repair of both valves with MitraClip was performed in 22 patients (median age 81.5 years, 32% female). Mean procedure time was 176 ± 47 min; mean fluoroscopy time was 65 ± 24 min. Procedure duration in the first tertile was significantly longer (223 ± 13 min) than in the third tertile (143 ± 23 min, p =.0003). Median number of total clips placed per case was 3; in 15 patients (68%), the anterior and septal leaflets of the TV were clipped. The average changes in mean right atrial (RA) and left atrial (LA) pressures were −1.7 ± 2.5 mmHg (p =.0080) and −3.2 ± 4.6 mmHg (p =.0045), respectively. The average changes in RA and LA V-wave heights were −3.3 ± 4.0 mmHg (p =.0009) and −8.1 ± 9.9 mmHg (p =.038), respectively. There was a significant trend toward decreasing residual TR over the course of the series (p =.046). At 30 days, survival was 100% and mean NYHA class decreased from 2.8 to 1.8 (p <.0001). Conclusions: Combined edge-to-edge tricuspid and mitral valve repair is safe and feasible. With experience, procedure duration and residual TR decreased.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • echocardiography
  • MitraClip
  • mitral valve insufficiency
  • tricuspid valve insufficiency

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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