Abstract
Concomitant tricuspid regurgitation (TR) is common in patients with mitral regurgitation (MR). While current guidelines recommend repair of both valves at the time of surgery when feasible, high risk patients are often undertreated, leading to significant morbidity and mortality. With advances in transcatheter edge-to-edge repair (TEER) devices and technique, combined TEER for treating significant MR and TR has emerged as a new tool for heart failure management. Recent evidence has shed light on which patients with severe TR should be targeted for transcatheter intervention either in isolation or in combination with a MV TEER procedure and allows for expanded treatment options in patients who otherwise would be limited to medical management. Technological advancements remain ahead of robust clinical data, and thus randomized clinical studies in patients with severe MR and TR will be instrumental in determining the best approach in treating these patients with transcatheter therapies.
Highlights
Transcatheter edge-to-edge repair (TEER) with the MitraClip (Abbott Vascular, Santa Clara, USA) has been demonstrated to be safe and effective in treating severe mitral regurgitation (MR) of both degenerative and functional etiologies [1, 2]
While transesophageal echocardiographic (TEE) is used for defining the precise mechanism of tricuspid regurgitation (TR), patient selection and procedural guidance, transthoracic echocardiography (TTE) is essential for assessment of the Tricuspid valve (TV) and quantifying right ventricular (RV) function under basal conditions [29]
Patients with dialysis-related TR had the greatest mortality with TTVr (33% at 1 year), while those with pulmonary hypertension had the highest rate of the primary endpoint of death, heart failure (HF) hospitalization, or reintervention
Summary
Transcatheter edge-to-edge repair (TEER) with the MitraClip (Abbott Vascular, Santa Clara, USA) has been demonstrated to be safe and effective in treating severe mitral regurgitation (MR) of both degenerative and functional etiologies [1, 2]. Multiple studies have shown increasing TR severity is associated with worse survival regardless of age, left (LV) or right ventricular (RV) dysfunction and pulmonary hypertension [7]. Both late residual TR seen after left-sided valve valve surgery [8] and isolated severe TR [6] carry excess mortality and morbidity. The aim of this article is to review the existing data on feasibility and benefits of combined transcatheter mitral and tricuspid repair and highlight the important considerations for patient selection and procedural success
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