New clip procedure on the tricuspid valve

Switzerland's first use of a new clip procedure on the tricuspid valve

Prof. Dr. med. Roberto Corti - Medical Director - Interventional Cardiology - HerzKlinik Hirslanden

On February 20, 2018, a team from HerzKlinik Hirslanden in Zurich inserted a newly designed clip for the treatment of a leaking heart valve (tricuspid valve) for the first time in Switzerland. Responsible for the new procedure are interventional cardiologists Prof. Roberto Corti, MD, and Prof. Peter Martin Wenaweser, MD, as well as imaging specialist PD Patric Biaggi, MD. The intervention is minimally invasive and thus offers the possibility to treat patients gently and without opening the chest.

Newly designed clip technology for the tricuspid valve

The clip technology was redesigned for use on the right-sided tricuspid valve. Based on the extensive experience with the use of clips on the mitral valve (left-sided heart valve), it was now possible to develop the

system can also be transferred to another heart valve. However, the technique and the clip had to be adapted to the different anatomy. Without effective treatment of severe tricuspid regurgitation, there is a risk of severe heart failure. Until now, leaking tricuspid valves could only be treated surgically or with medication, although open heart surgery is often too risky. Medication cannot eliminate the cause of the insufficiency and cannot significantly influence the course of the disease.

beating heart surgery

Prof. Dr. med. Peter M. Wenaweser - Interventional Cardiology - HerzKlinik Hirslanden

The catheter with the clip, which reunites the leaking parts, is inserted directly into the right ventricle via the inguinal vein. The minimally invasive procedure takes place under short anaesthesia and on the beating heart. The clip is optimally placed under 3D echocardiography and then released with good functional results. The metal clip remains permanently in the heart valve and grows in after about six months.

Improved quality of life and performance

On 20 February 2018, this new minimally invasive procedure was used for the first time in Switzerland. After the one-and-a-half-hour procedure, the 75-year-old patient was able to leave the Hirslanden Clinic in good health after just two days. Shortly after the procedure, the patient had a significantly improved quality of life and performance. Now the aim is to gain experience with the new technology in other patients. These patients will be selected for the new procedure after a thorough preliminary examination. Criteria include the anatomy of the valve and the cause of the leak.

Interdisciplinary feat

PD Patric Biaggi, MD - Cardiology Imaging - HerzKlinik Hirslanden

There are two challenges when inserting the tricuspid clip: "On the one hand, this is the creation of visibility, since we are not working on the open heart. And on the other hand, the perfect placement of the clip when the heart is beating and the valves are in motion," says Prof. Corti, MD. The surgeon's experience and dexterity are crucial when using the clip. "In order to control precisely and position the clip accurately, we use a combination of D3 ultrasound and a special X-ray procedure," adds Prof. Peter Martin Wenaweser, MD. The teamwork is crucial. Only when the two interventional cardiologists and the imaging specialists work hand in hand can the interdisciplinary feat succeed.

Source: media release 8 March 2019 (Hirslanden Clinic).