Author + information
- Received March 5, 2018
- Accepted April 3, 2018
- Published online June 18, 2018.
- Christian Besler, MDa,∗,
- Stephan Blazek, MDa,∗,
- Karl-Philipp Rommel, MDa,
- Thilo Noack, MDb,
- Maximilian von Roeder, MDa,
- Christian Luecke, MDc,
- Joerg Seeburger, MDb,d,
- Joerg Ender, MDe,
- Michael A. Borger, MDb,d,
- Axel Linke, MDa,
- Matthias Gutberlet, MDc,
- Holger Thiele, MDa,d and
- Philipp Lurz, MD, PhDa,d,∗ ()
- aDepartment of Cardiology, Heart Center Leipzig – University Hospital, Leipzig, Germany
- bDepartment of Cardiac Surgery, Heart Center Leipzig – University Hospital, Leipzig, Germany
- cDepartment of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- dLeipzig Heart Institute, Leipzig, Germany
- eDepartment of Anesthesiology, Heart Center Leipzig, Leipzig, Germany
- ↵∗Address for correspondence:
Dr. Philipp Lurz, Department of Internal Medicine/Cardiology, University of Leipzig–Heart Center, Strümpellstraße 39, 04289 Leipzig, Germany.
Objectives The present study aimed to test the clinical benefit of combined transcatheter mitral plus tricuspid valve edge-to-edge repair (TMTVR) as compared with transcatheter mitral valve edge-to-edge repair (TMVR) alone in patients with both significant mitral (MR) and tricuspid regurgitation (TR) at high surgical risk.
Background A growing number of patients with severe MR at increased surgical risk are treated by transcatheter techniques. Evidence suggests that residual TR remains a predictor of adverse outcome in these patients.
Methods Sixty-one patients (mean age 79.5 ± 8.4 years, EuroSCORE II 8.6 ± 5.9%) underwent TMTVR (n = 27) or TMVR (n = 34). Echocardiographic and cardiac magnetic resonance imaging was performed before and after the procedure.
Results Reduction of MR was similar in patients undergoing TMTVR and TMVR. Effective regurgitant orifice area of TR was reduced from 0.51 to 0.29 cm2 in patients with TMTVR (p < 0.01), but remained unchanged after TMVR. On cardiac magnetic resonance imaging, only patients in the TMTVR group exhibited improved effective right and left ventricular stroke volume, and increased cardiac index (2.1 vs. 2.5 l/min/m2; p < 0.01). TMTVR led to superior improvement in New York Heart Association functional class, NT-proBNP levels, and 6-min walking distance as compared with TMVR. After up to 18 months of follow-up, patients with TMTVR experienced fewer hospitalizations for heart failure when compared with patients with TMVR (p = 0.02), whereas rates of death were comparable between both groups of patients.
Conclusions TMTVR appears superior to TMVR in terms of cardiac output and functional improvement early after the intervention, and improves clinical outcome up to 18 months of follow-up.
- edge-to-edge repair
- mitral regurgitation
- mitral valve
- transcatheter therapy
- tricuspid regurgitation
- tricuspid valve
↵∗ The first 2 authors contributed equally to this work.
Dr. Borger has been on Speakers Bureaus and/or served as a consultant for Edwards Lifesciences, Medtronic, St. Jude Medical, and CryoLife. Dr. Lurz is a consultant to and has received speaker honoraria from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 5, 2018.
- Accepted April 3, 2018.
- 2018 American College of Cardiology Foundation
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