title: Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction.
abstract: OBJECTIVE
  The short-term outcomes were evaluated in patients treated for tricuspid valve endocarditis using a novel extracellular matrix (ECM) cylinder reconstruction technique.
  
  
  METHODS
  Patients with clinically significant tricuspid regurgitation whose valves were not repairable by conventional techniques underwent valve replacement with a cylindrical construct sewn out of CorMatrix ECM (CorMatrix Cardiovascular, Roswell, Ga). The cylinders were sized to the native valve dimensions and attached distally to the papillary muscles using polypropylene sutures and ECM pledgets, and proximally to the annulus using a running suture. Patient data were collected retrospectively.
  
  
  RESULTS
  From November 2011 to October 2013, 12 surgeons performed 19 tricuspid valve cylinder reconstructions in 8 men and 10 women (age range, 19-53 years). Of the 19 patients, 11 had active and 5 had treated endocarditis. One case was robotic-assisted. No deaths occurred, and no new cases of heart block developed. The papillary attachments were disrupted intraoperatively in 1 patient and after 7 days in another; both were successfully revised. A third patient experienced recurrent disruption of the implant at 13 and 22 months and ultimately received a pericardial valve. Fungal infection occurred in 1 cylinder at 6 months; a second ECM cylinder was implanted. Follow-up data were available for 13 patients at 1 to 2 months, 8 at 6 months, and 3 at 12 and 18 months. Other than patients undergoing reoperation, all showed well-functioning tricuspid valves with no to mild regurgitation.
  
  
  CONCLUSIONS
  Cylinder reconstruction with ECM could be a suitable technique for replacing the tricuspid valve while preserving annuloventricular continuity in patients with infective endocarditis not repairable by conventional techniques.
authors.affiliation: Franciscan St Francis Heart Center, Indianapolis, Ind. Electronic address: mgerdisch@openheart.net.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Gerdisch
authors.affiliation: University of California, Davis, Medical Center, Sacramento, Calif.
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Boyd
authors.affiliation: St Vincent's Hospital East, Birmingham, Ala.
authors.forename: John L
authors.initials: JL
authors.lastname: Harlan
authors.affiliation: St Vincent's Hospital East, Birmingham, Ala.
authors.forename: John B
authors.initials: JB
authors.lastname: Richardson
authors.affiliation: Baystate Medical Center, Springfield, Mass.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Flack
authors.affiliation: St Joseph's Hospital, Orange, Calif.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Palafox
authors.affiliation: Mobile Infirmary Medical Center, Mobile, Ala.
authors.forename: William E
authors.initials: WE
authors.lastname: Johnson
authors.affiliation: Minneapolis Heart Institute, Minneapolis, Minn.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sun
authors.affiliation: St Louis University Hospital Center for Comprehensive Cardiovascular Care, St Louis, Mo.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: Temple University School of Medicine, Philadelphia, Pa.
authors.forename: T Sloane
authors.initials: TS
authors.lastname: Guy
authors.affiliation: Banner Heart Hospital, Mesa, Ariz.
authors.forename: Gyu I
authors.initials: GI
authors.lastname: Gang
authors.affiliation: Division of Cardiothoracic Surgery Emeritus, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
authors.forename: James L
authors.initials: JL
authors.lastname: Cox
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D005109:Extracellular Matrix / Q000637:transplantation*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D014463:Ultrasonography; D055815:Young Adult