Intracardiac echocardiography to enable successful edge-to-edge transcatheter tricuspid valve repair in patients with insufficient TEE quality
Issue title: Selected papers of the 39th Conference of the German Society for Clinical Microcirculation and Hemorheology, 6-7 November 2020, Hannover, Germany
Guest editors: B. Hiebl, A. Krüger-Genge and F. Jung
Affiliations: [a] Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| [b]
Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Teltow, Germany
Correspondence:
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Corresponding author: Dr. Markus Reinthaler, Institute of Biomaterial Science, Helmholtz-Zentrum Geesthacht, Kantstraße 55, 14513 Teltow, Germany; and Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany. Tel.: +49 173 1989098; Fax: +49 30 450513999; E-mail: [email protected].
Note: [1] These authors contributed equally to this work
Abstract: BACKGROUND:Transesophageal echocardiography (TEE) as a guiding tool for edge-to-edge transcatheter tricuspid valve repair (EETVr) using MitraClip (Abbott Vascular, Santa Clara, USA) may not offer sufficient image quality in a significant proportion of patients. OBJECTIVES:Intracardiac echocardiography (ICE) as additional guiding tool in EETVr with the MitraClip device. METHODS:Appropriate angulations of the ICE catheter to visualize each commissure of the tricuspid valve were established in 3D printed heart models. In a single tertiary-care center ICE was used to support EETVr as additional guidance when TEE image quality was insufficient. Procedural safety and outcomes up to 30-days were compared between ICE/TEE and TEE only guided patients. RESULTS:In 6 of 11 patients (54.5%) undergoing EETVr with MitraClip TEE alone was unsatisfactory, necessitating additional ICE guidance. In 4 of these 6 patients ICE enabled a successful completion of the procedure. The steering maneuvers identified in the 3D models were well applicable in all patients, providing examples for potential future ICE implementation in EETVr. Under both TEE alone (n = 5) and ICE (n = 6) guidance the rate of procedural complications was 0%. According to vena contracta values at discharge significant TR reduction was achievable in the treated cohort (p = 0.011). At 30-days follow-up one patient (ICE guided) died following global heart failure, not associated with the procedure itself. CONCLUSIONS:ICE guidance may offer an additional tool to guide EETVr with the MitraClip device in patients with poor TEE quality, as it enables successful results without impairing procedural safety.
