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Case Reports
. 2020 Jun;7(3):915-919.
doi: 10.1002/ehf2.12577. Epub 2020 Mar 7.

Transcatheter edge-to-edge tricuspid repair for recurrence of valvular regurgitation after left ventricular assist device and tricuspid ring implantation

Martin Andreas  1 , Marco Russo  1 , Paul Werner  1 , Matthias Schneider  2 , Franziska Wittmann  1 , Sabine Scherzer  1 , Julia Mascherbauer  2 , Alfred Kocher  1 , Guenther Laufer  1 , Dominik Wiedemann  1 , Daniel Zimpfer  1
Affiliations
Case Reports

Transcatheter edge-to-edge tricuspid repair for recurrence of valvular regurgitation after left ventricular assist device and tricuspid ring implantation

Martin Andreas et al. ESC Heart Fail. 2020 Jun.

Abstract

Tricuspid regurgitation in patients with left ventricular assist device (LVAD) has a significant impact on prognosis and quality of life, and its effects on liver and renal function could negatively impact planned heart transplantation. The aim of the present case is to report the feasibility and the clinical impact of tricuspid transcatheter edge-to-edge repair in LVAD patients as adjunctive bridge to transplantation strategy. A 59-year-old female patient previously treated with LVAD implantation (HeartMate III) and tricuspid valve repair with 32 mm rigid ring (Medtronic Contour 3D) as bridge to transplantation developed recurrence of significant tricuspid regurgitation with right ventricular decompensation needing inotropic support. Preoperative echo showed torrential tricuspid valve regurgitation Effective regurgitant orifice area(EROA 1.4 cm2 ) with suspicious of partial detachment of the prosthetic ring. The patient was successfully treated with transcatheter edge-to-edge repair with the MitraClip XTR device. Tricuspid regurgitation was reduced by 50% (postoperative EROA 0.7 cm2 ). She remained stable under continuous inotropic support with no other episodes of right ventricular decompensation and was successfully transplanted 30 days after the clipping procedure. Transcatheter treatment of tricuspid regurgitation in a patient with LVAD was an effective strategy to gain time and bridge the patient to heart transplantation.

Keywords: Left ventricle assist device; Right ventricle failure; Transcatheter tricuspid repair; Tricuspid regurgitation.

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Conflict of interest statement

M. Andreas has a research grant and is proctor (Edwards, Abbott) and member of an advisory board (Medtronic). A. Kocher is consultant for Edwards Lifesciences and receives speaker fees from Medtronic, Boston Scientific and Abbott. D. Wiedemann is consultant for Abbott. D. Zimpfer receives research grants from Abbott and Medtronic, is advisory board member for Abbott, Medtronic and Berlin Heart, and proctor for Abbott and Medtronic. The other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Transoesophageal echocardiography findings. (A) Preoperative tricuspid valve regurgitation in four‐chambers view; (B) preoperative trans‐gastric short axis view; (C) 3D assessment (green arrow shows suspected ring detachment area); (D) postoperative residual tricuspid valve regurgitation.
Figure 2
Figure 2
(A) Fluoroscopy with fusion imaging features. IVC, inferior vena cava; SVC, superior vena cava; RA, right atrium; TV, tricuspid valve. (B) Post‐explant view. The green arrow shows the clip place in the postero‐septal commissure with single leaflet attachment to the posterior leaflet.
Figure 3
Figure 3
Pre (A) and post‐clipping (B) calculation of right ventricle cardiac output
See this image and copyright information in PMC

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