Sequential Implantation of Micra and TriClip for Massive Tricuspid Regurgitation and Sick Sinus Syndrome

Abstract

Severe tricuspid valve regurgitation (TR) is associated with high cardiovascular mortality. Safe and feasible interventional approaches to treat TR are of clinical relevance. Tricuspid transcatheter edge-to-edge repair (TEER) is a promising therapy for severe tricuspid regurgitation. Herein, we report an 81-year-old woman, with a history of double valve replacement, with recurrent symptomatic massive tricuspid regurgitation and sinus node dysfunction, in need of a permanent pacemaker. After the Heart Team discussion, we considered implanting a leadless pacemaker since such a device would not interfere with TEER. The procedure was successfully performed using the TriClip® device and tricuspid regurgitation was reduced to a moderate degree. In conclusion, TEER, in combination with a leadless pacemaker, is an alternative option for patients with an indication for a permanent pacemaker and massive tricuspid regurgitation to undergo a less invasive treatment rather than a potentially higher-risk reoperation.