Effectiveness of Artificial Neochordae Implantation in Tricuspid Valve Repair

Abstract

Various techniques for treating tricuspid regurgitation have been described; however, because of scarce data about the long-term outcomes of different repairs, the optimal technique has not been established. We evaluated the effectiveness and durability of artificial neochordae implantation in the treatment of tricuspid regurgitation.From 2009 through 2014, 507 patients underwent tricuspid valve repair at our institution. Of those, 48 patients implanted with artificial neochordae were included in our study. The median age of the participants was 62 years (range, 4-77 yr) and 50% were women. Thirty patients (63%) were in New York Heart Association functional class III, and 11 (23%) were in class II. The cause of tricuspid regurgitation was functional in 33 patients (69%) and rheumatic in 15 (31%). In 46 patients, neochordae implantation was performed in addition to Kay annuloplasty (n=13) or ring annuloplasty (n=33).Forty-two patients were discharged from the hospital with absent or mild tricuspid regurgitation. The mean follow-up period was 44.3 ± 20.2 months. Follow-up echocardiograms revealed that tricuspid regurgitation was absent, minimal, or mild in 38 patients (80.8%), moderate in 7, and severe in 2.Our results indicate that the use of artificial neochordae implantation as an adjunct procedure to annuloplasty leads to effective and durable repair in comparison with conventional techniques for treating tricuspid regurgitation. (Tex Heart Inst J 2019;46(2):100-6)

Morphological diversity of the tricuspid posterior leaflet affects surgical complexity for control of tricuspid regurgitation

“…If residual TR was found, we performed additional edge-to-edge repair at the sites of the leakage. Other techniques, such as artificial chords for prolapse cases, appear common, and Salihi et al reported that artificial neochordae implantation was effective as an adjunct procedure [19]. We selected edge-to-edge repair to simplify and unify the surgical technique.…”

Artificial Neochordae for Tricuspid Valve Repair in Adults: A Review

“…Another important contribution to this topic has been provided by Salihi et al who demonstrated the effectiveness of neochordal implantation in TR reporting 48 patients. 67 The median age was 62 years and 50% were females, but this series also included pediatric patients and the number of adult ones could not be identified. Finally, the possibility of using ePTFE neochordae for TVr in redo cardiac operations was stressed by Chen et al although any specific detail was not reported.…”

“…34,36,61 However, in rheumatic or long-standing posttraumatic TR, the valve leaflets may be thickened and strong enough to hold sutures without any reinforcement. 67 This review has obvious limitations. The main concern regards the impossibility to trace all patients having neochordae implantation for TVr.…”

“…34 36 61 However, in rheumatic or long-standing posttraumatic TR, the valve leaflets may be thickened and strong enough to hold sutures without any reinforcement. 67…”