Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2020 Nov;96(6):1323-1330. doi: 10.1002/ccd.28856. Epub 2020 Mar 17.
Transcatheter edge-to-edge repair with MitraClip is only approved for treatment of mitral regurgitation but is increasingly used to treat concomitant tricuspid regurgitation (TR) due to its common coexistence and association with poor outcomes. This study aimed to describe the learning curve associated with the challenge of off-label treatment of concomitant TR.
This is a retrospective review of initial and consecutive patients who underwent combined edge-to-edge repair of mitral and tricuspid valves (TVs) at our institution from August 2017 to October 2019.
Repair of both valves with MitraClip was performed in 22 patients (median age 81.5 years, 32% female). Mean procedure time was 176 ± 47 min; mean fluoroscopy time was 65 ± 24 min. Procedure duration in the first tertile was significantly longer (223 ± 13 min) than in the third tertile (143 ± 23 min, p = .0003). Median number of total clips placed per case was 3; in 15 patients (68%), the anterior and septal leaflets of the TV were clipped. The average changes in mean right atrial (RA) and left atrial (LA) pressures were -1.7 ± 2.5 mmHg (p = .0080) and -3.2 ± 4.6 mmHg (p = .0045), respectively. The average changes in RA and LA V-wave heights were -3.3 ± 4.0 mmHg (p = .0009) and -8.1 ± 9.9 mmHg (p = .038), respectively. There was a significant trend toward decreasing residual TR over the course of the series (p = .046). At 30 days, survival was 100% and mean NYHA class decreased from 2.8 to 1.8 (p < .0001).
Combined edge-to-edge tricuspid and mitral valve repair is safe and feasible. With experience, procedure duration and residual TR decreased.
经导管缘对缘修复术（MitraClip）仅被批准用于治疗二尖瓣反流，但由于其共同存在并与不良预后相关，越来越多地用于治疗同时存在的三尖瓣反流（TR）。本研究旨在描述与同时治疗 TR 的挑战性相关的学习曲线。
这是对 2017 年 8 月至 2019 年 10 月期间在我院接受二尖瓣和三尖瓣（TV）联合缘对缘修复的初始和连续患者的回顾性研究。
22 例患者（中位年龄 81.5 岁，32%为女性）接受了 MitraClip 治疗。平均手术时间为 176±47 分钟；平均透视时间为 65±24 分钟。第 1 三分位的手术时间明显长于第 3 三分位（223±13 分钟比 143±23 分钟，p =.0003）。每例患者放置的总夹数量中位数为 3 个；在 15 例患者（68%）中，TV 的前叶和隔叶被夹闭。平均右心房（RA）和左心房（LA）压力的变化分别为-1.7±2.5mmHg（p =.0080）和-3.2±4.6mmHg（p =.0045）。RA 和 LA V 波高度的平均变化分别为-3.3±4.0mmHg（p =.0009）和-8.1±9.9mmHg（p =.038）。随着研究的进行，残余 TR 呈显著下降趋势（p =.046）。30 天时，存活率为 100%，NYHA 分级平均从 2.8 级降至 1.8 级（p<.0001）。
联合缘对缘三尖瓣和二尖瓣修复是安全可行的。随着经验的积累，手术时间和残余 TR 减少。
