Percutaneous edge-to-edge repair of systemic tricuspid regurgitation in adults with congenital heart disease

Introduction

Systemic tricuspid valve regurgitation (TR) is often encountered in patients with atrial correction of transposition of the great arteries (acTGA) or congenitally corrected transposition of the great arteries (ccTGA). When at least moderate, it is related to impaired functional capacity, heart failure and mortality. Management is a matter of debate as medical management is limited and valvular surgery at risk. Among adults with severe and symptomatic systemic mitral regurgitation at high risk for surgery, percutaneous edge-to-edge repair is now proposed as a reasonable alternative.

Methods

We hypothetised that percutaneous management of systemic TR may be feasible and safe. A monthly national dedicated multidisciplinary meeting was therefore organized, including cardiologists and surgeons dedicated to adults with CHD. All concerned patients were evaluated and a decision was taken and thereafter offered to each patients.

Results/Expected results

So far, 9 patients, of whom 1 female, with a median age of 41 ± 14 years, were included, 4 with acTGA and 5 with ccTGA. The procedures were performed in 4 French tertiary CHD centers between May 2019 and June 2022, following institutional review board approval. The XTR MitraClip device (Abbott, Santa Clara, CA) was used, 1 MitraClip was used in 5 patients, 2 in 2 and 3 in 1. The procedure was not possible in 1 patient, because of impossibility to achieve appropriate orientation of the clip on the tricuspid valve. No complication was reported. At 6 months of follow-up, we noticed a decrease in the TR of at least 1 grade in 8 patients. NYHA functional class improved in 5 patients and diuretics doses decreased in 4.

Conclusion/Perspectives

Transcatheter edge-to-edge repair appears as a feasible and safe procedure in patients with significant systemic TR. Further studies need to be performed to precise the optimal position of percutaneous reduction of systemic TR in the management of these patients.