Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort

Guérin, Patrice; Jalal, Zakaria; Ruz, Robin Le; Cueff, Caroline; Hascoët, Sébastien; Bouvaist, Hélène; Ladouceur, Magalie; Lévy, F.; Hugues, Nicolas; Malekzadeh-Milani, S.; Leroux, Lionel; Modine, Thomas; Silini, Alexandre; Gallet, Jean; Saunier, Carole; Fresse, Karine Warin; Karam, Nicole; Vouhé, Pascal; Iserin, Laurence; Ghostine, Saïd; Iriart, Xavier; Gloan, Laurianne Le; Thambo, Jean Benoît

doi:10.1161/jaha.122.025628

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…To date, there only rare case reports available describing the use of TEER intervention to improve AVVR in adult congenital heart patients. 13 , 14 To our knowledge, this is the first successful published example of TEER through an extracardiac Fontan baffle puncture to successfully treat AV valve regurgitation in an adult.…”

Section: Discussionmentioning

confidence: 93%

First described mitral clip in an adult extracardiac Fontan patient: a case report

Haeffele

Peng

Chan

et al. 2022

European Heart Journal - Case Reports

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Background The use of transcatheter edge-to-edge repair (TEER) in patients with advanced heart failure has been shown to reduce hospitalizations and increase survival. As patients with Fontan circulations grow older, a significant proportion of them will develop severe atrio-ventricular valve regurgitation in the systemic ventricle. Conventional surgical repair and transplant carry high mortality risk for the adult Fontan patient with progressive heart failure. Case Summary A 51 year-old female extracardiac Fontan patient developed severe atrioventricular valve regurgitation and progressive functional decline. Based on her operative risk for conventional surgical intervention or transplant, TEER using the Abbott MitraClip device was performed. The degree of mitral regurgitation was decreased from severe to moderate regurgitation. Discussion This is the first known case describing the use of a successful TEER in an adult patient with an extracardiac Fontan. Given the increasing numbers of patients surviving into adulthood with a Fontan circulation, transcatheter interventions may provide an alternative treatment option to conventional surgeries and medical therapies.

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Section: Discussionmentioning

confidence: 93%

First described mitral clip in an adult extracardiac Fontan patient: a case report

Haeffele

Peng

Chan

et al. 2022

European Heart Journal - Case Reports

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“…There is increasing evidence supporting TEER as an AV therapy in high-risk adult patients, and there are further trials investigating expanding use in moderate-risk patients. 1,[21][22][23][24] While there have been case reports and a series of applications of TEER in CHD, [8][9][10][11][12]25 to date there has not been an organized effort to expand the use of TEER technologies to the heterogenous, anatomically complex CHD population due to the inherent challenges associated with widely varying anatomies, mechanisms of valve dysfunction, and delivery systems designed for "structurally normal" hearts.…”

Section: Discussionmentioning

confidence: 99%

“…As such, the development and application of an effective and minimally invasive therapy for AVVR would address a critical unmet need 6,7 . However, application of TEER in CHD, and in particular palliated single ventricle patients, is novel with limited description of outcomes 8−12 …”

Section: Introductionmentioning

confidence: 99%

Introduction of transcatheter edge‐to‐edge repair in patients with congenital heart disease at a children's hospital

Jolley,

Sulentic,

Amin

et al. 2023

Cathet Cardio Intervent

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BackgroundAtrioventricular valve regurgitation (AVVR) is a devastating complication in children and young adults with congenital heart disease (CHD), particularly in patients with single ventricle physiology. Transcatheter edge‐to‐edge repair (TEER) is a rapidly expanding, minimally invasive option for the treatment of AVVR in adults that avoids the morbidity and mortality associated with open heart surgery. However, application of TEER in in CHD and in children is quite novel. We describe the development of a peri‐procedural protocol including image‐derived pre‐intervention simulation, with successful application to four patients.AimsTo describe the initial experience using the MitraClip system for TEER of dysfunctional systemic atrioventricular valves in patients with congential heart disease within a pediatric hospital.MethodsA standardized screening and planning process was developed using cardiac magnetic resonance imaging, three dimensional echocardiography and both virtual and physical simulation. Procedures were performed using the MitraClip G4 system and patients were clinically followed post‐intervention.ResultsA series of four CHD patients with at least severe AVVR were screened for suitability for TEER with the MitraClip system: three patients had single ventricle physiology and Fontan palliation, and one had repair of a common atrioventricular canal defect. Each patient had at least severe systemic AVVR and was considered at prohibitively high risk for surgical repair. Each patient underwent a standardized preprocedural screening protocol and image‐derived modeling followed by the TEER procedure with successful clip placement at the intended location in all cases.ConclusionsThe early results of our protocolized efforts to introduce TEER repair of severe AV valve regurgitation with MitraClip into the CHD population within our institution are encouraging. Further investigations of the use of TEER in this challenging population are warranted.

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“…Transcatheter edge-to-edge valve repair with clip implantation has been used to treat mitral and TR in congenitally normal hearts. Case reports and series implanting clips in the SAVV tricuspid position in d-TGA and cc-TGA have also reported good clinical and echocardiographic improvement ( 115 ). Albeit more extensive studies with longer follow-ups are needed for validation, this percutaneous-based clip implantation may be suitable for sRV patients at high surgical risk ( 116 ).…”

Section: Management Of the Failing Systemic Right Ventriclementioning

confidence: 99%

Heart failure in systemic right ventricle: Mechanisms and therapeutic options

Sabbah

Arabi

Shafqat

et al. 2023

Front. Cardiovasc. Med.

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d-loop transposition of the great arteries (d-TGA) and congenitally corrected transposition of the great arteries (cc-TGA) feature a right ventricle attempting to sustain the systemic circulation. A systemic right ventricle (sRV) cannot support cardiac output in the long run, eventually decompensating and causing heart failure. The burden of d-TGA patients with previous atrial switch repair and cc-TGA patients with heart failure will only increase in the coming years due to the aging adult congenital heart disease population and improvements in the management of advanced heart failure. Clinical data still lags behind in developing evidence-based guidelines for risk stratification and management of sRV patients, and clinical trials for heart failure in these patients are underrepresented. Recent studies have provided foundational data for the commencement of robust clinical trials in d-TGA and cc-TGA patients. Further insights into the multifactorial nature of sRV failure can only be provided by the results of such studies. This review discusses the mechanisms of heart failure in sRV patients with biventricular circulation and how these mediators may be targeted clinically to alleviate sRV failure.

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Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort

Cited by 11 publications

References 5 publications

First described mitral clip in an adult extracardiac Fontan patient: a case report

First described mitral clip in an adult extracardiac Fontan patient: a case report

Introduction of transcatheter edge‐to‐edge repair in patients with congenital heart disease at a children's hospital

Heart failure in systemic right ventricle: Mechanisms and therapeutic options

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