First percutaneous Micra leadless pacemaker implantation and tricuspid valve repair with MitraClip NT for leadassociated severe tricuspid regurgitation

Gilbert H.L. Tang, Ryan Kaple, Martin Cohen, Tanya Dutta, Cenap Undemir, Hasan Ahmad, Angelica Poniros, Joanne Bennett, Cheng Feng, Steven Lansman

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Aims: Pacemaker lead-associated severe tricuspid regurgitation (TR) can lead to right heart failure and poor prognosis. Surgery in these patients carries significant morbidities. We describe a successful treatment of symptomatic severe TR by leadless pacemaker implantation followed by tricuspid valve (TV) repair with the MitraClip NT. Methods and results: A 71-year-old frail female with poor functional status, chronic atrial fibrillation and permanent pacemaker implantation in 2012 presented with symptomatic moderate-severe mitral regurgitation (MR) and severe TR with the pacemaker lead as the culprit. She was deemed extreme risk for double valve surgery and, because of her pacemaker dependency, the decision was to stage her interventions first with transcatheter mitral repair, then laser lead extraction and leadless pacemaker implantation to free the TV from tethering, then TV repair. An obstructive LAD lesion was identified and treated during mitral repair with the MitraClip NT. The Micra leadless pacemaker implantation and subsequent TV repair with the MitraClip NT were successful and the patient's MR improved to mild and TR to moderate, respectively. Conclusions: We report here a first successful transcatheter strategy to treat lead-associated severe TR by leadless pacemaker and MitraClip. Removing the pacemaker lead relieved leaflet tethering and improved the reparability of the TV.

Original languageEnglish
Pages (from-to)e1845-e1848
JournalEuroIntervention
Volume12
Issue number15
DOIs
StatePublished - Feb 2017
Externally publishedYes

Keywords

  • Atrioventricular block
  • Femoral
  • Mitral regurgitation
  • Mitral valve repair
  • Tricuspid disease

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