Valve repair for traumatic tricuspid regurgitation

Congenital or traumatic tricuspid regurgitation in the pediatric population, although generally well tolerated initially, may lead ultimately to right atrial and ventricular dilation and dysfunction with dysrhythmias. In order to preserve right atrial and ventricular function and maintain sinus rhythm, it is our objective to repair the regurgitant tricuspid valve at an early stage. In 5 children (mean age 8.8 years) with congenital tricuspid regurgitation (2 with Ebstein's anomaly, 1 each with ventricular septal defect, tetralogy of Fallot, and partial agenesis of chordae), and in 1 child with traumatic tricuspid regurgitation, the shortened (n = 4), congenitally absent (n = 1), and ruptured (n = 1) chordae tendineae of the anterior or septal leaflets or both, were repaired with polytetrafluoroethylene artificial chordae. The tricuspid valve was successfully reconstructed in all 6 patients. De Vega's (n = 3) or Danielson's (n = 2) plication of the tricuspid valve annulus was performed in 5 patients. At a mean follow-up time of 15.7 months, tricuspid valve function was normal in 2 patients and the other 4 had mild residual tricuspid regurgitation. The mean diameter of the tricuspid annulus decreased from 36.7 mm preoperatively to 30.0 mm postoperatively, which is in the range for children with a normal tricuspid valve. In congenital or traumatic tricuspid regurgitation, chordal replacement using polytetrafluoroethylene artificial chordae is a useful adjunct to the armamentarium of tricuspid valve repair. Early repair avoids deterioration of right atrial and ventricular function and promotes maintenance of sinus rhythm.

Download Full-text

Editorial comment on valve repair for traumatic tricuspid regurgitation

Multimedia Manual of Cardio-Thoracic Surgery ◽

10.1510/mmcts.2008.003251 ◽

2008 ◽

Vol 2008 (0328) ◽

Author(s):

M. De Bonis ◽

O. Alfieri

Keyword(s):

Editorial Comment ◽

Tricuspid Regurgitation ◽

Valve Repair ◽

Traumatic Tricuspid Regurgitation

Download Full-text

Faculty Opinions recommendation of Long-Term Outcomes of the FORMA Transcatheter Tricuspid Valve Repair System for the Treatment of Severe Tricuspid Regurgitation: Insights From the First-in-Human Experience.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736343783.793580323 ◽

2020 ◽

Author(s):

Michele De Bonis ◽

Benedetto Del Forno

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Human Experience ◽

Tricuspid Valve Repair ◽

Repair System ◽

Valve Repair ◽

Long Term Outcomes ◽

Severe Tricuspid Regurgitation

Download Full-text

Feasibility of a Novel Transcatheter Valve Repair System to Treat Tricuspid Regurgitation in ccTGA

JACC: Case Reports ◽

10.1016/j.jaccas.2021.04.024 ◽

2021 ◽

Vol 3 (6) ◽

pp. 893-896

Author(s):

Peter Luedike ◽

Matthias Riebisch ◽

Alexander Weymann ◽

Arjang Ruhparwar ◽

Tienush Rassaf ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Repair System ◽

Valve Repair ◽

Transcatheter Valve

Download Full-text

Favorable course of tricuspid regurgitation after percutaneous mitral valve repair is associated with improved survival and clinical outcome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1945 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Meijerink ◽

J Baan ◽

B.J Bouma

Keyword(s):

Mitral Valve ◽

Clinical Outcome ◽

Mitral Valve Repair ◽

Tricuspid Regurgitation ◽

Nyha Class ◽

Funding Source ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

All Cause Mortality

Abstract Background Tricuspid Regurgitation (TR) is often present in patients with mitral regurgitation (MR) and is associated with increased mortality and morbidity after percutaneous mitral valve repair (PMVR) using the MitraClip (Abbott Vascular). It is unclear to what extent TR is reduced after PMVR and whether the reduction of TR is related to survival and functional outcome. Purpose The aim of this study was to determine (1) the TR course after PMVR and (2) if this was related to survival and clinical outcome. Methods Patients who underwent PMVR and had complete echocardiographic data at baseline and follow-up were included. TR severity was graded as none, mild, moderate or severe (according to current guidelines) and was determined before treatment and at 6-months of follow up. Favorable TR course was defined as improvement of ≥1 grade or ≤ mild TR at 6-months. Clinical endpoints were all-cause mortality during 1-year of follow-up and improvement in New York Heart Association (NYHA) functional class after 6 months. Results A total of 67 patients were included (mean age 76 years, 57% male, 81% NYHA class ≥3 and 69% baseline TR ≥ moderate). Favorable TR course was achieved in 31 patients (46%) (figure 1A). All-cause mortality at 1 year was 7.5%, and was lower in the favorable TR course group (0% vs. 13.9%, p=0.057) (figure 1B). Improvement in NYHA class at 6-months was seen in 45% of patients without vs. 81% of patients with favorable TR course (p=0.01) (figure 1C). Conclusion A favorable TR course is achieved in 46% of PMVR patients and is associated with improved survival and improvement of NYHA class. The relatively high rate of an unfavorable TR course at 6-months, indicates that interventional treatment of the tricuspid valve might benefit these patients. TR course (A) and NYHA improvement (B) Funding Acknowledgement Type of funding source: Other. Main funding source(s): Abbott

Download Full-text

Tricuspid regurgitation after transcatheter mitral valve repair: Clinical course and impact on outcome

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29464 ◽

2021 ◽

Author(s):

Frank Meijerink ◽

Karel T. Koch ◽

Robbert J. Winter ◽

Daniëlle Robbers‐Visser ◽

S. Matthijs Boekholdt ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Tricuspid Regurgitation ◽

Clinical Course ◽

Valve Repair ◽

Transcatheter Mitral Valve Repair

Download Full-text

Tricuspid Valve Repair for the Poor Right Ventricle: Tricuspid Valve Repair in Patients with Mild-to-Moderate Tricuspid Regurgitation Undergoing Mitral Valve Repair Improves In-Hospital Outcome

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1399783 ◽

2015 ◽

Vol 65 (08) ◽

pp. 612-616 ◽

Cited By ~ 2

Author(s):

Michele Genoni ◽

Kirk Graves ◽

Dragan Odavic ◽

Helen Löblein ◽

Achim Häussler ◽

...

Keyword(s):

United States ◽

Mitral Valve ◽

Blood Transfusion ◽

Right Ventricle ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Operation Time ◽

Tricuspid Valve Repair ◽

Cell Saver ◽

Valve Repair

Background Tricuspid regurgitation (TR) in patients undergoing surgery for mitral valve (MV) increases morbidity and mortality, especially in case of a poor right ventricle. Does repair of mild-to-moderate insufficiency of the tricuspid valve (TV) in patients undergoing MV surgery lead to a benefit in early postoperative outcome? Methods A total of 22 patients with mild-to-moderate TR underwent MV repair and concomitant TV repair with Tri-Ad (Medtronic ATS Medical Inc., Minneapolis, Minnesota, United States) and Edwards Cosgrove (Edwards Lifesciences Irvine, California, United States) rings. The severity of TR was assessed echocardiographically by using color-Doppler flow images. The tricuspid annular plane systolic excursion (TAPSE) was under 1.7 cm. Additional procedures included coronary artery bypass (n = 9) and maze procedure (n = 15). The following parameters were compared: postoperative and peak dose of noradrenaline (NA), pre/postoperative systolic pulmonary pressure (sPAP), extubation time, operation time, cross-clamp time, cardiopulmonary bypass (CPB) time, pre/postoperative ejection fraction (EF), intensive care unit (ICU)-stay, hospital stay, cell saver blood transfusion, intra/postoperative blood transfusion, and postoperative TR. Results The mean age was 67 ± 14.8 years, 45% were male. Mean EF was 47 ± 16.2%, postoperative 52 ± 12.4%. sPAP was 46 ± 20.1 mm Hg preoperatively, sPAP was 40.6 ± 9.4 mm Hg postoperatively, NA postoperatively was 12 ± 10 μg/min, NA peak was 18 ± 11 μg/min, operation time was 275 ± 92 minutes, CPB was 145 ± 49 minutes, ICU stay was 2.4 ± 2.4 days, hospital stay was 10.8 ± 3.5 days, cell saver blood transfusion was 736 ± 346 mL, intraoperative transfusions were 2.5 ± 1.6. Two patients needed postoperative transfusions. A total of 19 patients were extubated at the 1st postoperative day, 2 patients at the 2nd day, and 1 at the 4th postoperative day. Two patients required a pacemaker. No reintubation, no in-hospital mortality, and one reoperation because of bleeding complications. Conclusion Correction of mild-to-moderate TR at the time of MV repair does maintain TV function and avoid right ventricular dysfunction in the early postoperative period improving the clinical outcome.

Download Full-text