Authors

• Karla Schwarz — University of Zagreb, Zagreb, Croatia
• Nino Petroci — University of Zagreb, Zagreb, Croatia — ORCID: 0009-0000-4371-4669
• Luka Perčin — University of Zagreb School of Medicine, Zagreb, Croatia — ORCID: 0000-0003-0497-6871
• Andrea Studen — University of Zagreb School of Medicine, Zagreb, Croatia — ORCID: 0000-0003-1835-3894
• Blanka Glavaš-Konja — University of Zagreb School of Medicine, Zagreb, Croatia — ORCID: 0000-0003-1134-4856
• Sandra Jakšić Jurinjak — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0002-7349-6137
• Joško Bulum — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1482-6503
• Boško Skorić — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5979-2346
• Zvonimir Ostojić — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0003-1762-9270
• Vlatka Rešković-Lukšić — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4721-3236
• Jadranka Šeparović-Hanževački — University of Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3437-6407

Abstract

**Introduction:** Transcatheter edge-to-edge repair (TEER) is a minimally invasive procedure aimed at treating patients with mitral or tricuspid regurgitation who are at high surgical risk. This technique allows access to the valves without open-heart surgery. A catheter, inserted through an intravenous line, guides a clip device (e.g. MitraClip or TriClip) to the affected valve, where it grasps the leaflets and pulls them together to reduce the regurgitation orifice (1, 2). **Methods and Results:** We analyzed 34 patients with mitral regurgitation treated with MitraClip. Among them, 14.7% (n=5) required two clips. The average follow-up was 18 ± 16 months, with a mortality rate of 14.7% (n=5), occurring on average 17 months post-procedure. Hospitalization for heart failure was necessary in 8.8% (n=3) of patients after a successful procedure, and re-intervention was required in 5.9% (n=2). We observed a significant reduction in NT-proBNP levels, declining from an average of 7516 pg/mL before the intervention to 1595 pg/mL afterward. The average daily dose of furosemide was significantly reduced from 150 mg to 88 mg. Importantly, NYHA functional status improved, reflecting better symptom management and enhanced functional capacity (**Figure 1**). Concerning tricuspid regurgitation, 12 patients underwent treatment with TriClip, with two clips required in 66.7% (n=8) of cases. The average follow-up period was 6 ± 4 months, with no mortality. Hospitalization for heart failure occurred in 25% (n=3). Post-procedure follow-up indicated notable improvement in NYHA status (**Figure 2**). FIGURE 1. New York Heart Association (NYHA) status before and after MitraClip (MC) procedure. FIGURE 2. New York Heart Association (NYHA) status before and after TriClip (TC) procedure. **Conclusion:** Both MitraClip and TriClip procedures significantly enhance the functional status of patients with mitral and tricuspid regurgitation. MitraClip treatment resulted in reductions in NT-proBNP levels and diuretic requirements. While some patients required re-intervention or hospitalization, overall mortality remained consistent with expectations. These findings demonstrate the effectiveness of TEER in improving quality of life and managing heart failure symptoms.

Keywords

mitral valve insufficiency, tricuspid valve insufficiency, transcatheter edge-to-edge repair

DOI

Literature

1. Silaschi M, Cattelaens F, Alirezaei H, Vogelhuber J, Sommer S, Sugiura A, et al. Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally Invasive Mitral Valve Surgery: An Observational Study. J Clin Med. 2024 February 28;13(5):1372. https://doi.org/10.3390/jcm13051372
2. Overtchouk P, Piazza N, Granada J, Soliman O, Prendergast B, Modine T. Advances in transcatheter mitral and tricuspid therapies. BMC Cardiovasc Disord. 2020 January 7;20(1):1. https://doi.org/10.1186/s12872-019-01312-3