Transcatheter edge-to-edge repair grasping the septal and anterior leaflets completely re-established physiological-like hemodynamics in an ex vivo model of functional tricuspid regurgitation.
Does transcatheter edge-to-edge repair improve hemodynamics in an ex vivo porcine model of functional tricuspid regurgitation?
In an ex vivo porcine model, transcatheter edge-to-edge repair of functional tricuspid regurgitation was most effective when grasping the septal and anterior leaflets.
BACKGROUND: Although associated with left heart pathologies, functional tricuspid regurgitation (FTR) is often left untreated during left heart surgery. Hence, owing to its degenerative character, reoperation is often needed, encompassing an impressive (25% to 35%) mortality rate. Thus transcatheter approaches to FTR are raising great interest. OBJECTIVES: The authors evaluated the post-treatment effectiveness of the edge-to-edge technique using the percutaneous mitral valve repair device in an ex vivo pulsatile model of FTR. METHODS: The devices were implanted in 11 porcine hearts simulating FTR. In each heart, single-clip treatments involved grasping leaflet pairs in the medial or commissural position (6 combinations). Two-clip treatments were then performed considering all possible 15 combinations of leaflet pairs and medial/commissural grasping. Cardiac output, mean pulmonary pressure, and mean diastolic valve pressure gradient were evaluated in physiological and simulated pathological conditions (FTR), and post-treatments. RESULTS: Grasping the septal and anterior leaflets allowed for the best post-procedural outcome, ensuring a complete re-establishment of physiological-like hemodynamics. Septal and posterior grasping induced a significant recovery from FTR, although less marked. Conversely, grasping the anterior and posterior leaflets did not reduce FTR, and was detrimental in some specific cases. CONCLUSIONS: This experimental work demonstrated that the transcatheter edge-to-edge repair technique is a feasible approach for FTR. The study investigated this approach to develop a selective, specific structural intervention methodology for treating FTR, considering the several biomechanical factors that alter proper functionality of valvular substructures. These results can be used to guide the development of edge-to-edge repair techniques in treatment of FTR.
Vismara et al. (Tue,) conducted a other in Functional tricuspid regurgitation (n=11). Transcatheter edge-to-edge repair vs. Simulated pathological conditions (baseline FTR) was evaluated on Cardiac output, mean pulmonary pressure, and mean diastolic valve pressure gradient. Transcatheter edge-to-edge repair grasping the septal and anterior leaflets completely re-established physiological-like hemodynamics in an ex vivo model of functional tricuspid regurgitation.