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Institutional learning experience for combined edge‐to‐edge tricuspid and mitral valve repair
Author(s) -
Mahowald Madeline K.,
Pislaru Sorin V.,
Reeder Guy S.,
Padang Ratnasari,
Michelena Hector I.,
Mankad Sunil V.,
Maalouf Joseph F.,
Guerrero Mayra,
Alkhouli Mohamad,
Rihal Charanjit S.,
Eleid Mackram F.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28856
Subject(s) - medicine , concomitant , mitraclip , fluoroscopy , mitral regurgitation , cardiology , regurgitation (circulation) , mitral valve , surgery , mitral valve repair , tricuspid valve
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.