Percutaneous Edge To Edge Repair for the treatment of severe Tricuspid valve Regurgitation in high-surgical risk patients with Systemic Right Ventricle: A Multicentric French Cohort (PETER TRESRIV)

Abstract

Patients with systemic right ventricle (SRV) (mostly congenitally-corrected transposition of thegreat arteries or transposition of the great arteries corrected by atrial switch) commonly developsignificant systemic tricuspid valve regurgitation and systemic right ventricular dysfunction inadulthood, both of which being a therapeutic dilemma for the care team. Until recently, the onlytherapeutic option has been surgery but the rate of complications is high. Percutaneous edge to edgerepair could be an alternative, especially for high-surgical risk patients. To describe clinical and paraclinical follow up of high-surgical risk patients with SRV and severe TR undergoing PETER. 10 high-risk surgical patients with severe systemic tricuspid regurgitation (TR) undergoing apercutaneous repair with the Mitraclip or Triclip system (Abbott) were included between May 2019and October 2021. We collected and compared clinical (symptoms, quality of life questionnaires), biological (renal function, BNP/ntproBNP levels), VO2 max testing, echocardiographic, and crosssectionnalimaging (tricuspid regurgitation severity, right ventricle dilatation and dysfunction) dataat baseline and 6 months after the procedure. We report a percutaneous implant success of 80%, one early death due to septal leaflet tear and 2early common flutters successfully ablated. Clinically, we describe a median improvement after 6months of functional status as well as physical (+10,3 points) and mental (+12,2 points) quality oflife scores. Biologically, BNP and ntproBNP median blood levels decreased (respectively of 162and 178 μmol/L). VO2 max testing parameters did not change significantly. TTE TR severityparameters EROA and regurgitation volume improved of respectively 20 mm 2 and 11 mL while MRIor TDM SRV volumes decreased in median of 25 ml/m 2 for diastolic and 22 ml/m 2 for systolicvolume, with an increase in RVEF of 18,5%. Percutaneous edge to edge repair of systemic tricuspid regurgitation might be a safe and effectivetherapeutic option in high-risk surgical adult patients.