Combined Mitral And Tricuspid Versus Isolated Mitral Valve Edge-to-edge Repair In Patients With Symptomatic Valve Regurgitation And High Surgical Risk
Thilo Noack1, Christian Besler2, Stephan Blazek2, Karl-Philipp Rommel2, Maximillian von Roeder2, Christian Luecke3, Karl Fengler2, Joerg Seeburger1, Joerg Ender4, Matthias Gutberlet3, Axel Linke2, Michael Andrew Borger1, Holger Thiele2, Philipp Lurz2.
1University Hospital for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany, 2University Hospital for Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany, 3Department for Radiology, Heart Center Leipzig, Leipzig, Germany, 4Department for Anesthesiology, Heart Center Leipzig, Leipzig, Germany.
Background: High-risk or inoperable patients with mitral regurgitation (MR) are treated by transkatheter edge-to-edge repair (TETER) using the MitraClip system, and accumulating evidence suggests that significant residual tricuspid regurgitation (TR) remains a predictor of adverse outcome in these patients. The aim of this study was to investigate the clinical benefit of combined MV plus TV as compared to MV edge-to-edge repair alone in patients with symptomatic MR and TR. Methods: Sixty-one patients (mean age 79.5 ± 8.4 years, EuroScore II 8.6 ± 5.9%) underwent either combined MV plus TV (n=27) or isolated MV (n=34) edge-to-edge repair. Patients underwent echocardiographic and cardiac magnetic resonance imaging (CMR) to investigate hemodynamic changes during the procedure. The clinical benefit was assessed by changes in NYHA functional class, NT-proBNP levels and 6-minute walk distance (6MWD) up to one month after the procedure. Results: MV edge-to-edge repair lead to a similar reduction of MR in both groups. Effective regurgitant orifice area of TR was reduced from 0.51 to 0.29 cm² in patients with combined repair (P<0.01), whereas it remained unchanged in patients with isolated MV repair. CMR imaging revealed a mild, but significant decrease of left ventricular ejection fraction in both groups (combined group: 46 vs. 41%, isolated group: 47 vs. 41%). Of note, cardiac output significantly increased only in the combined repair group (2.1 vs. 2.5 L/min/m², p<0.01), whereas no change significant change was observed in the isolated MR repair group. Combined repair lead to better improvement in NYHA functional class than isolated MV repair. NT-proBNP levels and 6MWD significantly improved in the combined, but not in the isolated MV repair group. Conclusion: Combined edge-to-edge repair of MV plus TV is superior to isolated MV repair in terms of cardiac output and functional improvement in high-risk or inoperable patients with symptomatic MR and TR.
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