Percutaneous Edge-to-Edge Repair of Atrioventricular Valves in Congenital Heart Disease

BACKGROUND: Transcatheter edge-to-edge repair (TEER) has become an established treatment for symptomatic atrioventricular valve regurgitation (AVVR). In congenital heart disease (CHD), AVVR is a major determinant of clinical outcomes. For these patients, surgery often poses high risk, underscoring the importance of percutaneous therapy. However, data supporting TEER in patients with CHD remain limited. OBJECTIVES: The objectives of the study were to examine the outcomes of TEER in CHD patients across several centers and to discuss the procedural considerations. METHODS: We conducted a retrospective review of atrioventricular TEER procedures performed on CHD patients across 5 medical centers. We analyzed patient demographics, procedural details, immediate (30 days), and intermediate (6-month) outcomes. RESULTS: A total of 20 patients with various CHD diagnoses underwent TEER, of which 18 reached the 6-month follow-up. The median age was 49.3 (Q1-Q3: 37.0-59.8) years and 40.0% were females. All cases were performed on the systemic circulation, 60.0% were tricuspid valves. All patients presented with symptomatic 3+ or 4+ degree AVVR at baseline, which was reduced to mild-to-moderate (1+ to 2+) in 19 patients (95.0%) at 30 days (P < 0.001). One death (5.0%) occurred in the first 30 days due to intractable heart failure; rates of NYHA functional class III-IV were reduced from 18 (90.0%) of the patients at baseline to 10.5% at 30 days. CONCLUSIONS: TEER for carefully selected patients with CHD and severe AVVR was safe and effective with notable improvements in regurgitation and clinical symptoms. Our findings highlight important considerations for planning and implementation of TEER in this patient population.