title: Impact of percutaneous mitral valve repair using the MitraClip system on tricuspid regurgitation.
abstract: OBJECTIVE
  Tricuspid regurgitation (TR) severity and right ventricular (RV) dysfunction have been identified as significant predictors of outcome after mitral valve surgery. The aim of the present study was to investigate the impact of percutaneous mitral valve repair (PMVR) with the MitraClip system on functional TR severity and RV function.
  
  
  RESULTS
  Among 119 consecutive patients with severe mitral regurgitation who underwent PMVR, 67 had complete baseline and follow-up transthoracic echocardiography after 3-12 months (6.8±2.9 months). TR severity was graded as mild, moderate, and severe. RV systolic function was assessed by fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE). Clinical endpoints at follow-up included mortality, reoperation of the mitral valve, hospitalisation for congestive heart failure and New York Heart Association (NYHA) functional class. After PMVR, a significant decrease in TR severity (by at least one grade) was observed in 22 (33%) patients, while an increase occurred in only seven (10%) patients (p=0.02). Overall, systolic RV function (FAC and TAPSE), RV dimensions, and tricuspid annular diameter did not change significantly. Baseline SPAP was significantly higher (57±15 vs. 43±14 mmHg, p=0.002) and SPAP reduction significantly larger (-14±13 versus 1±15 mmHg, p=0.012) in patients who improved their TR. Multivariate logistic regression analysis identified the change in SPAP as the only significant predictor of changes in TR (odds ratio [OR] [for every change in SPAP by 10 mmHg] 1.90, 95% CI: 1.02±3.54; p=0.044). Patients with mild/moderate TR at follow-up after PMVR had lower event rates compared to those with severe TR (35% vs. 78%, respectively, p=0.025).
  
  
  CONCLUSIONS
  PMVR using the MitraClip device improves functional TR severity in approximately one third of patients, particularly in those who experience a significant SPAP reduction after the procedure.
authors.affiliation: Andreas Grüntzig Cardiac Catheterization Laboratories, University Heart Center, Zurich, Switzerland.
authors.forename: Antonio H
authors.initials: AH
authors.lastname: Frangieh
authors.forename: Christiane
authors.initials: C
authors.lastname: Gruner
authors.forename: Fran
authors.initials: F
authors.lastname: Mikulicic
authors.forename: Adrian
authors.initials: A
authors.lastname: Attinger-Toller
authors.forename: Felix C
authors.initials: FC
authors.lastname: Tanner
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Jürg
authors.initials: J
authors.lastname: Grünenfelder
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüsche
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000601:surgery