Transcatheter Treatment of Tricuspid Regurgitation Using Edge-to-Edge Repair: Procedural Results, Clinical Implications and Predictors for Success

Objectives: Tricuspid valve repair using the MitraClip system is currently being evaluated as a novel transcatheter technique to treat TR.

Methods: Forty-two patients (76.8 ± 7.3 years, EuroSCORE II 8.1 ± 5.7) with high surgical risk and isolated TR or combined TR and mitral regurgitation (MR) underwent edge-to-edge repair of the TV (n = 11) or combined of the TV and mitral valve (n = 31). Procedural details, success rate, impact on TR severity and predictors for success at 30 day follow-up were analyzed.

Results: Successful edge-to-edge repair of TR was achieved in 35/42 patients (83%, 68 clips in total, 94% in the anteroseptal commissure, 6% in the posteroseptal commissure. In 5 patients, grasping of the leaflets was impossible and two patients had no decrease in TR after clipping. In those with procedural success, clipping of the TV led to a reduction in effective regurgitant orifice area by −62.5% (from 0.8 ± 0.4 to 0.3 ± 0.2 cm²; p < 0.0001). In both, patients with isolated TV and combined procedures, 6 minute walking distance improved (from 285 ± 118 to 344 ± 81 and 225 ± 113 to 261 ± 130 m, p = 0.02 and 0.03, respectively). Predominant anteroseptal or central TR was identified as predictor of procedural success (p = 0.025).

Conclusion: Edge-to-edge repair of the TV is feasible with promising early echocardiographic and clinical results of effectiveness.