https://doi.org/10.1007/s00392-025-02737-x
1Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland; 2Helios-Klinikum Erfurt Kardiologie & Internistische Intensivmedizin Erfurt, Deutschland; 3Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil gGmbH Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 4Helios-Klinikum Erfurt Allgemeine und Interventionelle Kardiologie und Rhythmologie Erfurt, Deutschland
Introduction:
In the past decade, edge-to-edge repair (TEER) for the treatment of mitral (MR) and tricuspid regurgitation (TR) has emerged as effective and safe therapeutic option in patients at high surgical risk. As MR and TR often coexist, the concomitant treatment of both valves is the standard approach in patients undergoing mitral surgery. However, it is still unclear whether both valves should be treated simultaneously using a percutaneous approach. Therefore, we aimed to retrospectively investigate the outcome of patients undergoing concomitant mitral and tricuspid edge-to edge repair (MT-TEER) in our institution throughout a 5 year period.
Methods and Results:
The characteristics, procedural data, and 1-year outcomes of all patients in this single center registry, who underwent MT-TEER were retrospectively compared.
Between 2019-2024, a total of 25 patients underwent combined MT-TEER in our institution. Due to completeness of data, 20 (female n=10, age 79±6,2 years) patients were included in this registry. All patients were treated using the Abbott MitraClip™ and TriClip™ system. Prior to CE-mark approval of the TriClip™ in 2021, the mitral clip was used off-label for compassionate treatment of the tricuspid valve in 5 patients.
On average, 1.05 clips were implanted on the mitral valve, and 1.3 clips were implanted on the tricuspid valve, with a mean procedural duration of 120±45. Treatment resulted in a signifacant reduction of MR and TR by a reduction of the regurgitant volume (RV) and EROA (mitral valve: RV -29±6,7 ml; p<0.001, EROA: -0,21±0,18 cm2; p<0.001; tricuspid valve: RV 17,7±8,5 ml; p<0.001, EROA: -0,23±0,12; p<0.001). The degree of insufficiency was reduced from MR grade 2,85 to grade 1,2 (p<0.001), TR grade 3,35 to grade 1,95 (p<0.001). No relevant complications at the puncture site or access route occurred in any of the 20 patients.
The mortality at 30 days was 0% (n=0) with 1 patient lost to follow up. At 1 year the estimated all-cause mortality was 28% (n=5) with 2 out of 20 patients lost to follow-up. The median survival time is 1304 days (95% confidence interval: 877–1731).
Regarding GFR and various right heart parameters like TAPSE/sPAP-ratio there was a positive trend post-intervention, although statistical significance was not achieved.
As an indicator for all-cause-mortallity a trend in TAPSE/sPAP-ratio could be observed (alive pre-intervention 0,5±0,21; dead at 1-year pre-intervention 0,37±0,14; alive post-intervention 0,62±0,37; dead at 1-year post-intervention 0,48±0,24), even though statistical significance could also not be reached.
Discussion:
In this study we demonstrate that simultaneous M and T- TEER is safe and feasible and significantly reduces the severity of both MR and TR. It therefore offers a valid approach for the future management of patients with bilateral valve insufficiencies. Randomized trials are necessary to investigate to clinical impact of the concomitant M and T-TEER versus the standard approach.