title: First percutaneous Micra leadless pacemaker implantation and tricuspid valve repair with MitraClip NT for lead-associated severe tricuspid regurgitation.
abstract: OBJECTIVE
  Pacemaker lead-associated severe tricuspid regurgitation (TR) can lead to right heart failure and poor prognosis. Surgery in these patients carries significant morbidities. We describe a successful treatment of symptomatic severe TR by leadless pacemaker implantation followed by tricuspid valve (TV) repair with the MitraClip NT.
  
  
  RESULTS
  A 71-year-old frail female with poor functional status, chronic atrial fibrillation and permanent pacemaker implantation in 2012 presented with symptomatic moderate-severe mitral regurgitation (MR) and severe TR with the pacemaker lead as the culprit. She was deemed extreme risk for double valve surgery and, because of her pacemaker dependency, the decision was to stage her interventions first with transcatheter mitral repair, then laser lead extraction and leadless pacemaker implantation to free the TV from tethering, then TV repair. An obstructive LAD lesion was identified and treated during mitral repair with the MitraClip NT. The Micra leadless pacemaker implantation and subsequent TV repair with the MitraClip NT were successful and the patient's MR improved to mild and TR to moderate, respectively.
  
  
  CONCLUSIONS
  We report here a first successful transcatheter strategy to treat lead-associated severe TR by leadless pacemaker and MitraClip. Removing the pacemaker lead relieved leaflet tethering and improved the reparability of the TV.
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA.
authors.forename: Gilbert H L
authors.initials: GH
authors.lastname: Tang
authors.forename: Ryan
authors.initials: R
authors.lastname: Kaple
authors.forename: Martin
authors.initials: M
authors.lastname: Cohen
authors.forename: Tanya
authors.initials: T
authors.lastname: Dutta
authors.forename: Cenap
authors.initials: C
authors.lastname: Undemir
authors.forename: Hasan
authors.initials: H
authors.lastname: Ahmad
authors.forename: Angelica
authors.initials: A
authors.lastname: Poniros
authors.forename: Joanne
authors.initials: J
authors.lastname: Bennett
authors.forename: Cheng
authors.initials: C
authors.lastname: Feng
authors.forename: Steven
authors.initials: S
authors.lastname: Lansman
mesh_terms: D000368:Aged; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000601:surgery; D010138:Pacemaker, Artificial; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*