First transfemoral percutaneous edge-to-edge repair of the tricuspid valve using the MitraClip system.

AIMS: While severe tricuspid regurgitation contributes significantly to morbidity and a poor prognosis in heart failure patients, isolated surgical repair of the tricuspid valve is associated with a high mortality, especially in patients with prior surgery. Percutaneous tricuspid valve repair could contribute to the solution of this dilemma. A recently published report demonstrated the feasibility of tricuspid edge-to-edge repair with the MitraClip® system (Abbott Vascular, Santa Clara, CA, USA) using a transjugular route. In a highly symptomatic patient with severe functional tricuspid regurgitation unsuitable for surgery, we aimed to reduce tricuspid regurgitation using a modified deployment technique for the MitraClip system using a femoral access.

METHODS AND RESULTS: A 78-year-old male patient with dilated cardiomyopathy was admitted for his fifth episode of acutely decompensated, predominantly right-sided, heart failure in ten months. Echocardiography showed a moderately to severely reduced left ventricular function and severe functional tricuspid regurgitation. Two clips were deployed in the anterior-septal and posterior-septal commissure of the tricuspid valve, resulting in a significant reduction of the effective regurgitant orifice area. The midterm clinical state of the patient improved.

CONCLUSIONS: In our patient with severe functional tricuspid regurgitation and suitable anatomy, transfemoral percutaneous tricuspid valve repair was technically feasible and safe by using a modified deployment technique of a widely used repair system developed for the mitral valve. The procedure can be performed without technical modification of the device via a transfemoral route and under echocardiographic guidance. However, particular anatomic and technical aspects can compromise an initial procedural success and demand specific considerations in the future.