Transcatheter treatment of tricuspid regurgitation using edge-to-edge repair: procedural results, clinical implications and predictors of success

Aims: The aim of this study was to analyse the feasibility, safety and effectiveness of tricuspid valve (TV) repair using the MitraClip system in patients at high surgical risk. Methods and results: Forty-two elderly high-risk patients (76.8 +/- 7.3 years, EuroSCORE II 8.1 +/- 5.7) with isolated TR or combined TR and mitral regurgitation (MR) underwent edge-to-edge repair of the TV (n=11) or combined edge-to-edge repair of the TV and mitral valve (n=31). Procedural details, success rate, impact on TR severity and predictors of success at 30-day follow-up were analysed. 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 five 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 cm(2); p<0.0001). In both patients with isolated TV and combined procedures, six-minute walking distance improved (from 285 +/- 118 to 344 +/- 81 m and from 225 +/- 113 to 261 +/- 130 m, p=0.02 and 0.03, respectively). Predominant anteroseptal or central TR was identified as a predictor of procedural success (p=0.025). Conclusions: Edge-to-edge repair of the TV is feasible with a promising reduction in TR, which could result in clinical improvement.