Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)
Summary
Aetna considers transcatheter edge-to-edge repair with an FDA-approved device, such as the MitraClip NTR/XTR Clip Delivery System, medically necessary for chronic mitral regurgitation that remains symptomatic despite maximal doses of medical therapy in members with symptomatic severe primary mitral regurgitation who are not considered good candidates for mitral valve surgery, or with symptomatic severe secondary mitral regurgitation who have a left ventricular ejection fraction between 20% and 50%, a left ventricular end-systolic diameter of 70 mm or less, and a pulmonary artery systolic pressure of 70 mmHg or less. Transcatheter mitral valve-in-valve replacement with an FDA-approved device, such as the Edwards-Sapien 3 valve, is considered medically necessary for symptomatic failing surgical bioprosthetic mitral valves when a heart team including a cardiac surgeon judges the member to be at high or greater risk for open surgical therapy, meaning a predicted risk of surgical mortality of 8% or higher at 30 days. Transcatheter edge-to-edge repair with the TriClip device is considered medically necessary for severe tricuspid regurgitation with symptomatic heart failure when all listed criteria are met, while caval valve implantation, transcatheter tricuspid valve replacement, and trans-apical mitral valve repair are considered experimental, investigational, or unproven.
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