A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions.
OBJECTIVE
Correction of tricuspid regurgitation due to complex lesions (not treatable with annuloplasty only) is associated with suboptimal results. To improve the efficacy of valve repair in this context, we developed a new surgical approach, which consists of stitching together the central part of the free edges of the leaflets producing a 'clover' shaped valve. Our preliminary experience with this novel technique is reported.


METHODS
Between 2001 and 2003, 14 patients (mean age 57+/-17 years), with severe tricuspid regurgitation due to complex lesions, underwent valve repair with this novel approach in combination with annuloplasty. The aetiology of the disease was post-traumatic in five cases, degenerative in eight and secondary to dilated cardiomyopathy in one. Anterior leaflet prolapse/flail was present in most patients associated with posterior and/or septal leaflet prolapse or tethering. Annular and right ventricular dilatation was present in all cases. Mitral valve repair/replacement was concomitantly performed in nine patients.


RESULTS
Hospital mortality was 7.1% (1/14). At follow-up extending to 22 months (mean 12+/-6.3), all survivors were asymptomatic. At the last echocardiogram tricuspid regurgitation was absent or mild in 13 patients and moderate in one. Mean tricuspid valve area and gradient were 4.2+/-0.4 cm(2) and 2.7+/-1.4 mmHg, respectively.


CONCLUSIONS
Despite the short follow-up, this novel technique appears to be an easy, rapid and effective approach to correct severe tricuspid regurgitation due to complex lesions. Such a repair restored tricuspid valve competence, even in the presence of huge RV dilatation and pulmonary hypertension.
De Bonis
Michele
M
Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. michele.debonis@hsr.it
Lapenna
Elisabetta
E
La Canna
Giovanni
G
Grimaldi
Antonio
A
Maisano
Francesco
F
Torracca
Lucia
L
Caldarola
Alessandro
A
Alfieri
Ottavio
O
D000328:Adult; D000368:Aged; D004452:Echocardiography; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000150:complications