Abstract
Purpose Transcatheter mitral valve edge-to-edge repair using the MitraClip system (Abbott Vascular, USA) has been used for several years in high-risk patients with isolated severe mitral regurgitation. Clipping of the tricuspid valve using the MitraClip system was introduced recently.Tricuspid regurgitation requiring valve repair is frequent in the context of LVAD support. To our knowledge a transfemoral clipping of tricuspid valve during LVAD support using the MitraClip system has not been performed so far and is here reported for the first time. Methods A 56-year old woman developed severe tricuspid regurgitation 4 weeks after LVAD implantation. The logistic EuroScore was 28.36%. We found a sufficient right ventricular function (TAPSE 24 mm, S´ 7-11 cm/s, FAC 46 %). Indication for tricuspid clipping was done after evaluating anatomical conditions. A clip delivery system was introduced via transfemoral approach (24/22 french) into the right atrium. Thereafter guiding catheter was angulated slightly in “plus” and “anterior” directions to position the guiding catheter vertically to the tricuspid valve. The next step of the maneuver consisted of advancing the MitraClip device into the right atrium, opening both arms, centering and advancing the system into the right ventricle. By retracting the MitraClip device both leaflets (anterior and septal) were grasped and closed to coapt the tricuspid leaflets. After an effective reduction of tricuspid regurgitation had been achieved, the clip was deployed. The clip delivery system and guiding catheter were withdrawn. Results Reconstruction of the two- and three-dimensional transesophageal echocardiographic dataset documented a significant echocardiographic improvement with an effective reduction of tricuspid regurgitation from grade III° to grade I° without any stenosis. The patient tolerated the procedure very well and was discharged 3 days after the implantation. 6 months after implantation the patient is doing well with a tricuspid regurgitation grad I°. No clip detachment was found. Conclusion In conclusion, it has been shown that transfemoral tricuspid valve repair using the MitraClip system during LVAD support could be a feasible, safe and well-tolerated therapy for this special indication without renewed surgical intervention.
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