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Percutaneous Edge-to-Edge Repair of Atrioventricular Valves in Congenital Heart Disease: A Multicenter Clinical
Leor Perl1, Antonio Popolo Rubbio2, Francesco Bedogni2
1Division of Cardiology, Rabin Medical Center - Beilinson Hospital, Petah-Tikva, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel. Electronic address: https://twitter.com/LeorPerl.
Insights
Transcatheter edge-to-edge repair (TEER) effectively treated severe atrioventricular valve regurgitation (AVVR) in congenital heart disease (CHD) patients. This percutaneous therapy improved symptoms and reduced regurgitation, offering a safe option for high-risk individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Atrioventricular valve regurgitation (AVVR) significantly impacts outcomes in congenital heart disease (CHD) patients.
- Transcatheter edge-to-edge repair (TEER) is an established treatment for symptomatic AVVR.
- Limited data exists on TEER efficacy in the CHD population, where surgery carries high risk.
Purpose of the Study:
- To evaluate the outcomes of TEER in patients with CHD across multiple centers.
- To identify procedural considerations for performing TEER in this specific patient group.
Main Methods:
- Retrospective review of TEER procedures in CHD patients from 5 medical centers.
- Analysis of patient demographics, procedural specifics, and short-term (30-day) and intermediate (6-month) outcomes.
Main Results:
- Twenty CHD patients underwent TEER, with 18 completing 6-month follow-up.
- Significant reduction in severe AVVR to mild-to-moderate levels in 95% of patients at 30 days (P < 0.001).
- Reduced rates of severe functional limitation (NYHA class III-IV) from 90% to 10.5% at 30 days; one early death (5%) due to heart failure.
Conclusions:
- TEER is a safe and effective treatment for carefully selected CHD patients with severe AVVR.
- The procedure leads to substantial improvements in both valve regurgitation and clinical symptoms.
- Findings emphasize key considerations for planning and executing TEER in the CHD population.
Background:
Transcatheter edge-to-edge repair (TEER) has become an established treatment for symptomatic atrioventricular valve regurgitation (AVVR). In congenital heart disease (CHD), AVVR is a major determinant of clinical outcomes. For these patients, surgery often poses high risk, underscoring the importance of percutaneous therapy. However, data supporting TEER in patients with CHD remain limited.
Objectives:
The objectives of the study were to examine the outcomes of TEER in CHD patients across several centers and to discuss the procedural considerations.
Methods:
We conducted a retrospective review of atrioventricular TEER procedures performed on CHD patients across 5 medical centers. We analyzed patient demographics, procedural details, immediate (30 days), and intermediate (6-month) outcomes.
Results:
A total of 20 patients with various CHD diagnoses underwent TEER, of which 18 reached the 6-month follow-up. The median age was 49.3 (Q1-Q3: 37.0-59.8) years and 40.0% were females. All cases were performed on the systemic circulation, 60.0% were tricuspid valves. All patients presented with symptomatic 3+ or 4+ degree AVVR at baseline, which was reduced to mild-to-moderate (1+ to 2+) in 19 patients (95.0%) at 30 days (P < 0.001). One death (5.0%) occurred in the first 30 days due to intractable heart failure; rates of NYHA functional class III-IV were reduced from 18 (90.0%) of the patients at baseline to 10.5% at 30 days.
Conclusions:
TEER for carefully selected patients with CHD and severe AVVR was safe and effective with notable improvements in regurgitation and clinical symptoms. Our findings highlight important considerations for planning and implementation of TEER in this patient population.
