Transcatheter edge-to-edge repair (TEER) with the MitraClip XTR device is a safe, effective treatment option for patients with significant tricuspid regurgitation (TR), according to new findings published in JACC: Cardiovascular Interventions.
However, the authors noted, clinicians should still be cautious if the coaptation gap size (CGS) is especially large.
“Studies using the MitraClip NT device suggested that a CGS >7.2 mm predicted poor procedural success,” wrote Tobias Friedrich Ruf, MD, a cardiologist at University Medical Center Mainz in Germany, and colleagues. “The larger third-generation MitraClip XTR system, with 12-mm arm lengths, could theoretically treat greater CGS. In this report, we present clinical outcomes from 50 patients treated with the MitraClip XTR system for symptomatic, significant TR.”
Clinical and echocardiographic evaluations from before the procedure and 30 days after implantation were available for each patient. All echocardiograms were assessed at a laboratory in New York City. Patients were separated into three subgroups based on their CGS: subgroup I (CGS <7 mm), subgroup II (CGS 7 to 10 mm), and subgroup III (CGS >10 mm).
After closely examining patient outcomes, the team also used logistic regression to assess a patient’s probability of device success—defined as moderate or less TR—depending on their CGS.
The technical success rate with the MitraClip XTR device was 100%. After 30 days, single-leaflet detachment was observed in 6% of patients. TR was reduced by one grade for patients in subgroup 1 and by two grades for patients in subgroups II and III. The procedure results in a lower New York Heart Association functional class for patients in all CGS subgroups.
Overall, the team found, the MitraClip XTR device should provide “optimal echocardiographic and clinical results” if the patient’s CGS is 8.4 mm or less. This represents a significant improvement compared to prior solutions. If the patient has a CGS greater than 8.4, “combined therapies or transcatheter tricuspid valve replacement may be an option.”
Abbott, the manufacturer behind the MitraClip XTR, did provide funding for this analysis. Also, multiple—but not all—study authors reported a working relationship with Abbott.
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