Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort
2022; Wiley; Volume: 11; Issue: 10 Linguagem: Inglês
10.1161/jaha.122.025628
ISSN2047-9980
AutoresPatrice Guérin, Zakaria Jalal, Robin Le Ruz, Caroline Cueff, Sébastien Hascoët, Hélène Bouvaist, Magalie Ladouceur, Franck Lévy, Nicolas Hugues, Sophie Malekzadeh‐Milani, Lionel Leroux, Thomas Modine, Alexandre Silini, Jean Gallet, Carole Saunier, Karine Warin Fresse, Nicole Karam, Pascal Vouhé, Laurence Iserin, Saïd Ghostine, Xavier Iriart, Laurianne Le Gloan, Jean Benoit Thambo,
Tópico(s)Congenital Heart Disease Studies
ResumoHomeJournal of the American Heart AssociationVol. 11, No. 10Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort Open AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toOpen AccessLetterPDF/EPUBPercutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort Patrice Guerin, MD, PhD, Zakaria Jalal, MD, PhD, Robin Le Ruz, MD, Caroline Cueff, MD, Sebastien Hascoet, MD, PhD, Hélène Bouvaist, MD, Magalie Ladouceur, MD, PhD, Franck Levy, MD, Nicolas Hugues, MD, Sophie‐Guiti Malekzadeh‐Milani, MD, PhD, Lionel Leroux, MD, PhD, Thomas Modine, MD, PhD, Alexandre Silini, MD, Jean Gallet, MD, Carole Saunier, MD, Karine Warin Fresse, MD, Nicole Karam, MD, PhD, Pascal Vouhe, MD, PhD, Laurence Iserin, MD, Said Ghostine, MD, PhD, Xavier Iriart, MD, Laurianne Le Gloan, MD and Jean Benoit Thambo, MD, PhD Patrice GuerinPatrice Guerin * Correspondence to: Patrice Guerin, MD, PhD, Service de Cardiologie, CHU de Nantes ‐ Hôpital Nord ‐Laennec, Bvd Jacques Monod, 44093 Nantes Cedex, France. Email: E-mail Address: [email protected] https://orcid.org/0000-0002-8095-8897 Congenital Cardiology Unit, , Institut du Thorax, , Inserm UMRS 791, , University Hospital of Nantes, , France , Zakaria JalalZakaria Jalal https://orcid.org/0000-0002-4968-8526 Department of Pediatric and Adult Congenital Cardiology, , University Hospital of Bordeaux, , Bordeaux, , France LIRYC Electrophysiology and Heart Modeling Institute, , Fondation Bordeaux Université, , Bordeaux, , France INSERM, , Centre de Recherche Cardio‐Thoracique de Bordeaux, , Pessac, , France , Robin Le RuzRobin Le Ruz https://orcid.org/0000-0002-8964-6611 Congenital Cardiology Unit, , Institut du Thorax, , Inserm UMRS 791, , University Hospital of Nantes, , France , Caroline CueffCaroline Cueff Institut du Thorax, , University Hospital of Nantes, , France , Sebastien HascoetSebastien Hascoet https://orcid.org/0000-0002-8695-0503 Paediatric and Congenital Cardiac Surgery Department, , M3C Marie‐Lannelongue Hospital, , National Reference Centre, , Groupe Hospitalier Saint‐Joseph, Paris Saclay University, , Plessis‐Robinson, , France , Hélène BouvaistHélène Bouvaist Department of Cardiology, , University Hospital of Grenoble, , France , Magalie LadouceurMagalie Ladouceur https://orcid.org/0000-0002-4325-3521 Adult Congenital Heart Disease Unit, , Department of Cardiology, , Centre de référence des Malformations Cardiaques Congénitales Complexes, , M3C, , Hôpitaux de Paris, Hôpital Européen Georges Pompidou, , Paris, , France , Franck LevyFranck Levy Cardiothoracic Center of Monaco, , Monaco , Nicolas HuguesNicolas Hugues Cardiothoracic Center of Monaco, , Monaco , Sophie‐Guiti Malekzadeh‐MilaniSophie‐Guiti Malekzadeh‐Milani M3C‐Necker Enfants Malades, , AP‐HP, , Paris, , France , Lionel LerouxLionel Leroux CHU Bordeaux, Hôpital Haut‐Lévêque, , Pessac, , France , Thomas ModineThomas Modine https://orcid.org/0000-0003-4169-3766 CHU Bordeaux, Hôpital Haut‐Lévêque, , Pessac, , France , Alexandre SiliniAlexandre Silini Department of Pediatric and Adult Congenital Cardiology, , University Hospital of Bordeaux, , Bordeaux, , France LIRYC Electrophysiology and Heart Modeling Institute, , Fondation Bordeaux Université, , Bordeaux, , France INSERM, , Centre de Recherche Cardio‐Thoracique de Bordeaux, , Pessac, , France , Jean GalletJean Gallet Congenital Cardiology Unit, , Institut du Thorax, , Inserm UMRS 791, , University Hospital of Nantes, , France , Carole SaunierCarole Saunier Department of Cardiology, , University Hospital of Grenoble, , France , Karine Warin FresseKarine Warin Fresse Non‐Invasive Imaging Unit, , Institut du Thorax, , University Hospital of Nantes, , Nantes, , France , Nicole KaramNicole Karam European Hospital Georges Pompidou (Cardiology Department), , Paris University, , Paris, , France Paris Cardiovascular Research Center (INSERMU970), , Paris, , France , Pascal VouhePascal Vouhe M3C‐Necker, , Hôpital Universitaire Necker‐Enfants Malades, APHP, , Paris, , France , Laurence IserinLaurence Iserin https://orcid.org/0000-0002-4862-9719 Adult Congenital Heart Disease Unit, , Department of Cardiology, , Centre de référence des Malformations Cardiaques Congénitales Complexes, , M3C, , Hôpitaux de Paris, Hôpital Européen Georges Pompidou, , Paris, , France , Said GhostineSaid Ghostine Paediatric and Congenital Cardiac Surgery Department, , M3C Marie‐Lannelongue Hospital, , National Reference Centre, , Groupe Hospitalier Saint‐Joseph, Paris Saclay University, , Plessis‐Robinson, , France , Xavier IriartXavier Iriart https://orcid.org/0000-0002-4911-7432 Department of Pediatric and Adult Congenital Cardiology, , University Hospital of Bordeaux, , Bordeaux, , France LIRYC Electrophysiology and Heart Modeling Institute, , Fondation Bordeaux Université, , Bordeaux, , France INSERM, , Centre de Recherche Cardio‐Thoracique de Bordeaux, , Pessac, , France , Laurianne Le GloanLaurianne Le Gloan Congenital Cardiology Unit, , Institut du Thorax, , Inserm UMRS 791, , University Hospital of Nantes, , France and Jean Benoit ThamboJean Benoit Thambo Department of Pediatric and Adult Congenital Cardiology, , University Hospital of Bordeaux, , Bordeaux, , France LIRYC Electrophysiology and Heart Modeling Institute, , Fondation Bordeaux Université, , Bordeaux, , France INSERM, , Centre de Recherche Cardio‐Thoracique de Bordeaux, , Pessac, , France Originally published16 May 2022https://doi.org/10.1161/JAHA.122.025628Journal of the American Heart Association. 2022;11:e025628Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 16, 2022: Ahead of Print In patients with congenital heart diseases (CHD) such as congenitally corrected transposition of the great arteries (ccTGA), transposition of the great arteries with surgical atrial switch, or functional single ventricles, systemic tricuspid regurgitation (STR) is frequent. STR may be the consequence or the origin of systemic right ventricular dysfunction and can lead to progressive heart failure and death. Surgical correction of STR is a high‐risk procedure, especially when systemic right ventricular dysfunction is severe, and heart transplantation may be the only alternative.1In adults with degenerative mitral or tricuspid regurgitation, percutaneous edge‐to‐edge repair (PETER) using a clip device is effective and leads to a reduction of valvular regurgitation and improvement of clinical status.2 This approach could be extended to patients with CHD with complex mitral and/or tricuspid failure.3 However, available literature is mostly dedicated to the mitral valve. Recently, we described the first percutaneous repair of STR with successful implantation of the MitraClip system in a patient with TGA with surgical atrial switch.4Here, we report our experience with PETER in a series of 12 patients with CHD with STR using the MitraClip system. All data and supporting materials have been provided with the published article. The study was approved by the institutional review committee and all patients gave their informed consent.Twelve patients (median age, 35 years; 83% men) with severe STR (ccTGA [n=5], atrial correction for TGA (acTGA) [n=3], single ventricles [n=4]), at high‐risk for surgical treatment, gave informed consent for treatment using PETER. The procedures were performed in 5 French tertiary CHD centers between June 2019 and September 2021, following institutional review board approval. The XTR MitraClip device (Abbott, Santa Clara, CA) was used. At baseline, 7 of 12 patients were in New York Heart Association functional class ≥III. Standard femoral venous access was successfully used in 10 of 12 patients. In patients with single ventricles, the systemic valve was accessed directly through the right atrium (n=2), after a Fontan conduit puncture (n=1), or after direct atrial surgical access (n=1). In patients with TGA, either transseptal (patients with ccTGA, n=4) or transbaffle (patients with TGA with surgical atrial switch, n=3) puncture was performed.4 In 1 patient with situs inversus, levocardia, and ccTGA, a first attempt using the right femoral access did not allow a correct orientation of the clip on the tricuspid valve owing to complex anatomy, and a direct left atrium surgical access via right thoracotomy was used.MitraClip devices were successfully implanted in 11 of 12 patients (1 device: n=9, 2 devices: n=2) at first attempt in 10 patients3, 4 (Figure) and after a second procedure requiring surgical access and 2 devices in the patient with situs inversus, levocardia, and ccTGA. One procedural complication was reported for a patient with a single ventricle in whom a septal leaflet rupture occurred following clip release, leading to severe STR; the patient died from refractory cardiac failure 1 week later. Peri‐procedural complications included 1 case of left femoral vein injury treated by implantation of a covered stent and 1 case of atrial flutter treated by catheter ablation. After a median follow‐up of 12 months (range, 1–25) following device implantation, no death had occurred. The patients had significant reduction in STR (from severe to moderate in 10 of 11 patients) and clinically improved (10 of 11 patients were in New York Heart Association class I or II). Cardiac magnetic resonance performed in 6 patients at 6 months, showed a decrease in median right ventricular end‐diastolic volumes from 201 mL/m2 (range, 126–260) to 161 mL/m2 (range, 115–227) and an improvement of right ventricular ejection fraction from 37% (range, 28%–50%) to 49% (range, 37%–62%).Download figureDownload PowerPointFigure 1. Standard percutaneous edge‐to‐edge repair procedure in patients with transposition of the great arteries with surgical atrial switch, patients with congenitally corrected transposition of the great arteries, and patients with single ventricle.AL indicates anterior leaflet; AV, aortic valve; AVV, atrioventricular valve; IAB, interatrial baffle; LA, left atrium; LV, left ventricle; MV, mitral valve; PVC, pulmonary venous channel; RA, right atrium; SL, septal leaflet; SRV, systemic right ventricle; SVC, superior vena cava; TGA, transposition of the great arteries; TSP, transseptal puncture; and TVA, tricuspid valve annulus. *MitraClip.To the best of our knowledge, this is the first case series of patients with CHD with STR treated by PETER. This series confirms the technical feasibility of the procedure and its positive impact on patients' symptoms and right ventricular function after a median follow‐up of 12 months. In patients with STR, the main difficulty is to navigate the clip through complex anatomies, which may not allow orientation of the device perpendicularly to the tricuspid annulus, thus leading to procedural failure. This technical issue, which is frequent in patients with TGA, was reported in our series for 1 patient with ccTGA presenting with situs inversus and levocardia.Concerns about the potential damage caused by failed PETER therapy compromising subsequent surgery have been raised following treatment of mitral regurgitation5 and are legitimate when the clip is used to address STR. Nevertheless, because patient survival and STR recurrence tend to be worse after STR repair than after STR replacement, tricuspid replacement is the preferred procedure when surgery is required.2 Hence, the risk that PETER could be a limitation for subsequent surgical tricuspid valve repair seems irrelevant. In our series, 1 patient had a leaflet rupture following clip release leading to refractory heart failure, but bailout surgery was precluded by poor global condition.To conclude, percutaneous edge‐to‐edge therapy of STR in patients with CHD is feasible, safe, and effective to reduce STR and systemic right ventricular dilatation. This reduction is associated with a significant clinical improvement. Larger studies and longer follow‐up are warranted to confirm these promising results.Sources of FundingJalal, Iriart, Leroux, and Thambo have received financial support from the French Government as part of the "Investments of the future" program managed by the National Research Agency (ANR), Grant reference ANR‐10‐IAHU‐04.DisclosuresThe authors declare the following relationships with industry: Patrice Guerin is a consultant for Abbott and has received research grants from Abbott; Nicole Karam is a consultant for Abbott and has received research grants from Abbott; Lionel Leroux is a consultant for Abbott and has received research grants from Abbott.AcknowledgmentsWe would like to thank Dr. Gilles Bosser, Department of Pediatric and Adult Congenital Cardiology, University Hospital of Nancy, Nancy, France for his contribution to this work.Footnotes* Correspondence to: Patrice Guerin, MD, PhD, Service de Cardiologie, CHU de Nantes ‐ Hôpital Nord ‐Laennec, Bvd Jacques Monod, 44093 Nantes Cedex, France. Email: patrice.[email protected]frFor Sources of Funding and Disclosures, see page 3.References1 Scherptong RW, Vliegen HW, Winter MM, Holman ER, Mulder BJ, van der Wall EE, Hazekamp MG. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle: repair or replace?Circulation. 2009; 119:1467–1472. doi: 10.1161/CIRCULATIONAHA.108.805135LinkGoogle Scholar2 Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38:2739–2791. doi: 10.1093/eurheartj/ehx391CrossrefMedlineGoogle Scholar3 Alshawabkeh L, Mahmud E, Reeves R. Percutaneous mitral valve repair in adults with congenital heart disease: Report of the first case‐series. Catheter Cardiovasc Interv. 2021; 97:542–548. doi: 10.1002/ccd.29238CrossrefMedlineGoogle Scholar4 Iriart X, Guérin P, Jalal Z, Thambo J‐B. Edge to edge repair using a MitraClip for severe tricuspid valve regurgitation after a Mustard operation. Catheter Cardiovasc Interv. 2021; 98:E108–E114. doi: 10.1002/ccd.29681CrossrefMedlineGoogle Scholar5 Monsefi N, Zierer A, Khalil M, Ay M, Beiras‐Fernandez A, Moritz A, Stock UA. Mitral valve surgery in 6 patients after failed MitraClip therapy. Tex Heart Inst J. 2014; 41:609–612. doi: 10.14503/THIJ‐13‐3626CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails May 17, 2022Vol 11, Issue 10Article InformationMetrics Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley BlackwellThis is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.https://doi.org/10.1161/JAHA.122.025628PMID: 35574967 Manuscript receivedFebruary 3, 2022Manuscript acceptedApril 15, 2022Originally publishedMay 16, 2022 Keywordssystemic right ventricular dysfunctionpercutaneous valve repairtransposition of the great arteriestricuspid valvecongenitally correctedPDF download SubjectsCatheter-Based Coronary and Valvular InterventionsCongenital Heart DiseaseValvular Heart Disease
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