L. Le Gloan , X. Iriart , H. Bouvaist , Y. Lavie-Badie , E. Hereau , P. Guérin
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A monthly national dedicated multidisciplinary meeting was therefore organized, including cardiologists and surgeons dedicated to adults with CHD. All concerned patients were evaluated and a decision was taken and thereafter offered to each patients.</p></div><div><h3>Results/Expected results</h3><p>So far, 9 patients, of whom 1 female, with a median age of 41<!--> <!-->±<!--> <span><span><span>14 years, were included, 4 with acTGA and 5 with ccTGA. The procedures were performed in 4 French tertiary CHD centers between May 2019 and June 2022, following institutional review board approval. The XTR MitraClip device (Abbott, Santa Clara, CA) was used, 1 MitraClip was used in 5 patients, 2 in 2 and 3 in 1. The procedure was not possible in 1 patient, because of impossibility to achieve appropriate orientation of the clip on the tricuspid valve. No complication was reported. 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A monthly national dedicated multidisciplinary meeting was therefore organized, including cardiologists and surgeons dedicated to adults with CHD. All concerned patients were evaluated and a decision was taken and thereafter offered to each patients.</p></div><div><h3>Results/Expected results</h3><p>So far, 9 patients, of whom 1 female, with a median age of 41<!--> <!-->±<!--> <span><span><span>14 years, were included, 4 with acTGA and 5 with ccTGA. The procedures were performed in 4 French tertiary CHD centers between May 2019 and June 2022, following institutional review board approval. The XTR MitraClip device (Abbott, Santa Clara, CA) was used, 1 MitraClip was used in 5 patients, 2 in 2 and 3 in 1. The procedure was not possible in 1 patient, because of impossibility to achieve appropriate orientation of the clip on the tricuspid valve. No complication was reported. 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引用次数: 0
摘要
系统性三尖瓣返流(TR)常见于心房矫正大动脉转位(acTGA)或先天性矫正大动脉转位(ccTGA)患者。当至少中度时，它与功能受损、心力衰竭和死亡率有关。管理是一个有争议的问题，因为医疗管理是有限的，瓣膜手术有风险。对于有严重症状性全身性二尖瓣反流且手术风险高的成年人，经皮边缘到边缘修复现在被建议作为一种合理的选择。方法我们假设经皮处理全身TR可能是可行和安全的。因此，每月组织一次全国多学科会议，包括专门治疗成人冠心病的心脏病专家和外科医生。对所有有关病人进行评估并作出决定，然后向每位病人提供。结果/预期结果纳入9例患者，其中女性1例，中位年龄41±14岁，acTGA 4例，ccTGA 5例。经机构审查委员会批准，该手术于2019年5月至2022年6月在4个法国三级冠心病中心进行。使用XTR MitraClip装置(Abbott, Santa Clara, CA)， 5例患者使用1例MitraClip, 2例2例，3例1例。由于无法在三尖瓣上实现夹的适当定位，1例患者无法进行该手术。无并发症报道。在6个月的随访中，我们注意到8例患者的TR至少降低了1级。5例患者NYHA功能分级改善，4例患者利尿剂剂量减少。结论/观点超声导管边缘到边缘修复术在严重全身TR患者中是一种可行且安全的治疗方法。在这些患者的治疗中，需要进一步的研究来确定经皮全身TR复位的最佳位置。
Percutaneous edge-to-edge repair of systemic tricuspid regurgitation in adults with congenital heart disease
Introduction
Systemic tricuspid valve regurgitation (TR) is often encountered in patients with atrial correction of transposition of the great arteries (acTGA) or congenitally corrected transposition of the great arteries (ccTGA). When at least moderate, it is related to impaired functional capacity, heart failure and mortality. Management is a matter of debate as medical management is limited and valvular surgery at risk. Among adults with severe and symptomatic systemic mitral regurgitation at high risk for surgery, percutaneous edge-to-edge repair is now proposed as a reasonable alternative.
Methods
We hypothetised that percutaneous management of systemic TR may be feasible and safe. A monthly national dedicated multidisciplinary meeting was therefore organized, including cardiologists and surgeons dedicated to adults with CHD. All concerned patients were evaluated and a decision was taken and thereafter offered to each patients.
Results/Expected results
So far, 9 patients, of whom 1 female, with a median age of 41 ± 14 years, were included, 4 with acTGA and 5 with ccTGA. The procedures were performed in 4 French tertiary CHD centers between May 2019 and June 2022, following institutional review board approval. The XTR MitraClip device (Abbott, Santa Clara, CA) was used, 1 MitraClip was used in 5 patients, 2 in 2 and 3 in 1. The procedure was not possible in 1 patient, because of impossibility to achieve appropriate orientation of the clip on the tricuspid valve. No complication was reported. At 6 months of follow-up, we noticed a decrease in the TR of at least 1 grade in 8 patients. NYHA functional class improved in 5 patients and diuretics doses decreased in 4.
Conclusion/Perspectives
Transcatheter edge-to-edge repair appears as a feasible and safe procedure in patients with significant systemic TR. Further studies need to be performed to precise the optimal position of percutaneous reduction of systemic TR in the management of these patients.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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