First transfemoral percutaneous edge-to-edge repair of the tricuspid valve using the MitraClip system.
OBJECTIVE
While severe tricuspid regurgitation contributes significantly to morbidity and a poor prognosis in heart failure patients, isolated surgical repair of the tricuspid valve is associated with a high mortality, especially in patients with prior surgery. Percutaneous tricuspid valve repair could contribute to the solution of this dilemma. A recently published report demonstrated the feasibility of tricuspid edge-to-edge repair with the MitraClip® system (Abbott Vascular, Santa Clara, CA, USA) using a transjugular route. In a highly symptomatic patient with severe functional tricuspid regurgitation unsuitable for surgery, we aimed to reduce tricuspid regurgitation using a modified deployment technique for the MitraClip system using a femoral access.


RESULTS
A 78-year-old male patient with dilated cardiomyopathy was admitted for his fifth episode of acutely decompensated, predominantly right-sided, heart failure in ten months. Echocardiography showed a moderately to severely reduced left ventricular function and severe functional tricuspid regurgitation. Two clips were deployed in the anterior-septal and posterior-septal commissure of the tricuspid valve, resulting in a significant reduction of the effective regurgitant orifice area. The midterm clinical state of the patient improved.


CONCLUSIONS
In our patient with severe functional tricuspid regurgitation and suitable anatomy, transfemoral percutaneous tricuspid valve repair was technically feasible and safe by using a modified deployment technique of a widely used repair system developed for the mitral valve. The procedure can be performed without technical modification of the device via a transfemoral route and under echocardiographic guidance. However, particular anatomic and technical aspects can compromise an initial procedural success and demand specific considerations in the future.
Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
Tobias
T
Wengenmayer
Manfred
M
Zehender
Wolfgang
W
Bothe
Christoph
C
Bode
Sebastian
S
Grundmann
D000368:Aged; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*