Edge-to-edge Transcatheter treatment of mitral and tricuspid regurgitation

Valvular heart disease is increasingly prevalent in the aging population. Mitral regurgitation (MR) and tricuspid regurgitation (TR) both affect up to 10% of individuals over 75 years and are associated with increased morbidity and mortality rates. Transcatheter edge-to-edge mitral valve repair (TEER) is indicated in patients with symptomatic MR deemed high-risk for mitral valve surgery. The procedure is being performed more frequently, highlighting the critical importance of optimizing its planning, execution, and effectiveness. Concomitant TR is often present in those with significant MR (mainly due to pulmonary hypertension and right ventricular pressure or volume overload) and is known to affect outcome after TEER. Isolated TR is mostly functional in its etiology as a result of annular dilatation and right ventricular remodeling. Most patients with significant TR are deemed high risk for surgery due to the presence of right ventricular dysfunction, advanced age, and other comorbidities. Until recently, these patients could only be treated with medical therapy. Transcatheter edge-to-edge tricuspid valve repair is now available as well. In this thesis, we investigated (1) clinical decision making for TEER, (2) potential tools to optimize TEER, (3) the role of concomitant TR in MR patients, and (4) the early experience of transcatheter edge-to-edge TV repair.