Retrospective analysis of tricuspid valve repair using a novel surgical technique: A 7-year single-surgeon experience

Abstract

Objectives: Tricuspid annuloplasty is the optimal surgical repair technique for tricuspid regurgitation which improves mortality and morbidity. Ring annuloplasties is the techniques of choice. Here, we evaluate the efficacy and durability of a new method of interrupted pledgeted suture annuloplasty.

Methods: Between 2011 and 2018, 39 eligible patients underwent tricuspid valve repair using this novel technique. Indication for repair was a grade of regurgitation at moderate or greater, or an annular diameter >40 mm. Patients were assessed both preoperatively and postoperatively by echocardiogram. Follow-up results were split into the first postoperative echocardiogram and most recent postoperative echocardiogram undertaken.

Results: There were two in-hospital mortalities and two patients required permanent pacemaker implantation following surgery. At the time of the first postoperative echocardiogram undertaken (median 3 months postoperatively), freedom from moderate-severe regurgitation was 92.3%. At the time of the most recent postoperative echocardiogram undertaken (median 11 months postoperatively); none or mild regurgitation was detected in 24 patients (61.5%), mild-moderate in 11 (28.2%) and moderate-severe in 4 (10.3%) patients. Freedom from moderate-severe regurgitation was 89.7%. Postoperative grade of regurgitation was significantly reduced from preoperative grades (p < 0.001).

Conclusion: Initial and midterm results of our technique show a good durability of repair. We have demonstrated recurrence rates of regurgitation equal and superior to current forms of suture annuloplasty published in the literature. This novel method of suture annuloplasty can be considered in the surgical repertoire of tricuspid valve repair techniques.

Keywords: cardiac surgery; novel suture annuloplasty; tricuspid repair; tricuspid valve; tricuspid valve surgery.

Figure 1.

Novel method of interrupted suture annuloplasty: (a) The first pledget is embedded at the posteroseptal commissure, exit pledgets emerge 6-8 mm from the entry pledget. (b) The first suture is tied and cut; the interrupted pattern is repeated along the circumference of the annulus. (c) The final repair consists on average of eight sutures, which are each double pledgeted. The last suture is placed at the anteroseptal commissure.

Figure 2.

Change in prevalence within each grade of tricuspid regurgitation between preoperative and postoperative status. N = 39 both preoperatively and postoperatively.

Figure 3.

The interplay of pathophysiological determinants on annular dilatation and ultimately tricuspid regurgitation. AF: atrial fibrillation; LAP: left atrial pressure; RV: right ventricle; TR: tricuspid regurgitation.