Publish in this journal
Journal Information
Vol. 73. Issue 12.
Pages 1085-1086 (December 2020)
Vol. 73. Issue 12.
Pages 1085-1086 (December 2020)
Letter to the Editor
Full text access
Simultaneous percutaneous repair in mitral and tricuspid regurgitation: step by step
Reparación percutánea simultánea en la insuficiencia mitral y tricuspídea: paso a paso
Juan Diego Sánchez Vega
Corresponding author

Corresponding author:
, Luisa Salido Tahoces, José Luis Zamorano, Ángel Sánchez-Recalde
Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
Related content
Berenice Caneiro-Queija, Rodrigo Estévez-Loureiro, Francisco Calvo-Iglesias, José A. Baz-Alonso, Emad Abu-Assi, Andrés Íñiguez-Romo
Rodrigo Estévez-Loureiro, Berenice Caneiro-Queija, José Antonio Baz, Andrés Íñiguez-Romo
Article information
Full Text
Download PDF
Full Text
To the Editor,

We read with interest the recently-published scientific letter by Caneiro-Queija et al.,1 in which they showed the possibility of combined treatment of mitral regurgitation (MR) and tricuspid regurgitation (TR) in a single procedure using MitraClip devices. It does indeed demonstrate the high levels at which operators and structural intervention are currently working, but we would like to raise some points regarding the indication for performing the 2 repairs in a single procedure.

First, while it is quite normal in surgical procedures to repair several valves in a single operation, in interventional cardiology this aspect may generate some controversy. Longer duration of the procedure is associated with an increased risk of complications associated with vascular access,2 the need for a longer anesthetic,3 increased use of ionizing radiation, and more transesophageal ultrasound time.4

Second, with currently-available medical treatment, the short-term mortality from TR, even in its most severe forms, is low, especially in patients who maintain good functional status.5

Third, the 2 valvulopathies are closely dependent. It has been demonstrated that correction of MR, independently of the technique, significantly reduces left ventricular filling pressures and pulmonary hypertension.6 In the case of the MitraClip, between a third and a half of patients have a significant reduction in TR grade following MR repair.7,8 It is therefore more than reasonable to wait and see the results before planning a second procedure, especially in cases with little dilatation of the tricuspid annulus and a structurally normal valve.

Fourth, the use of several devices in a single procedure implies a higher financial burden, which means rigorous selection of appropriate candidates is essential, especially since a high percentage of cases of TR improve after MR repair.

Last, there is little experience of the benefit of performing both repair procedures in combination. Only one study has indicated that a certain survival benefit could be obtained, but there were many limitations to its design, and it compared mitral repair alone against simultaneous repair of both valves, but not against staged repair.9

The percutaneous repair of TR represents a major advance and hope, particularly for patients who are not candidates for surgery.10–14 Although nobody would question combined repair in a surgical procedure, in percutaneous procedures this is more controversial. A randomized study is needed to compare simultaneous repair of both valves against a staged approach based on the results on TR.


Á. Sánchez-Recalde is associate editor of Revista Española de Cardiología; the journal's established editorial procedure to ensure impartial management of the manuscript has been followed.

B. Caneiro-Queija, R. Estévez-Loureiro, F. Calvo-Iglesias, J.A. Baz-Alonso, E. Abu-Assi, A. Íñiguez-Romo.
Tratamiento percutáneo combinado de la insuficiencia mitral y tricuspídea con sistema MitraClip: primera experiencia en España.
A.C. Paganin, M.G. Beghetto, M.K. Feijo, et al.
Complicaciones vasculares en pacientes sometidos a procedimientos cardiológicos endovasculares: cohorte multicéntrica.
Rev Latino-Am Enfermagem., 26 (2018), pp. e3060
H. Cheng, J.W. Clymer, B. Po-Han, et al.
Prolonged operative duration is associated with complications: a systematic review and meta-analysis.
J Surg Res., 229 (2018), pp. 134-144
A. Freitas-Ferraz, M. Bernier, R. Vaillancourt, et al.
Safety of transesophageal echocardiography to guide structural cardiac interventions.
J Am Coll Cardiol., 75 (2020), pp. 3164-3173
P. Mahía, R. Aguilar, J.A. De Agustín, et al.
Medida tridimensional del área del anillo tricúspide. Un nuevo criterio en la selección de candidatos a anuloplastia.
Rev Esp Cardiol., 72 (2019), pp. 732-739
S. Barth, M.B. Hautmann, S. Kerber, et al.
Hemodynamic improvement at three months after MitraClip® treatment in end-stage heart failure patients with functional mitral regurgitation.
J Heart Valve Dis., 25 (2016), pp. 475-482
A.H. Frangieh, C. Gruner, F. Mikulicic, et al.
Impact of percutaneous mitral valve repair using the Mitraclip system on tricuspid regurgitation.
EuroIntervention., 11 (2016), pp. e1680-e1686
Y. Ohno, G.F. Attizani, D. Capodanno, et al.
Association of tricuspid regurgitation with clinical and echocardiographic outcomes after percutaneous mitral valve repair with the Mitraclip system: 30-day and 12-month follow-up from the GRASP Registry.
Eur Heart J Cardiovasc Imaging., 15 (2014), pp. 1246-1255
M. Mehr, N. Karam, M. Taramasso, et al.
Combined tricuspid and mitral versus isolated mitral valve repair for severe MR and TR: an analysis from the TriValve and TRAMI Registries.
JACC Cardiovasc Interv., 3 (2020), pp. 543-550
A. Sánchez-Recalde, R. Hernández-Antolín, L. Salido Tahoces, A. García-Martín, C. Fernández-Golfin, J.L. Zamorano.
Transcatheter tricuspid annuloplasty with the Cardioband device to treat severe functional tricuspid regurgitation.
Rev Esp Cardiol., 73 (2020), pp. 503-515
R. Estévez-Loureiro, V. Moñivas, C. Arellano-Flores, A. Forteza, C. Martín, J. Goicolea.
Reemplazo percutáneo de la válvula tricúspide con prótesis autoexpandible dedicada: sistema GATE.
Rev Esp Cardiol., 72 (2019), pp. 1081-1083
A. Iñiguez-Romo, J.A. Baz, F.E. Calvo-Iglesias, J. Encisa, E. Abu-Assi.
Tratamiento percutáneo de la insuficiencia tricúspide mediante una endoprótesis valvulada.
Rev Esp Cardiol., 72 (2019), pp. 1083
C.-H. Li, X. Millan, H. Capellades, L. Danduch, A. Serra, D. Arzamendi.
Multimodalidad y fusión de imágenes en el tratamiento percutáneo de la insuficiencia tricúspide.
Rev Esp Cardiol., 72 (2019), pp. 421-422
A. Latib, J. Curio, A. Mangieri.
Más herramientas para una necesidad no cubierta: nuevas opciones para el tratamiento percutáneo de la insuficiencia tricuspídea.
Rev Esp Cardiol., 72 (2019), pp. 991-993
Copyright © 2020. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

View newsletter history
Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?