Surgical Techniques for Tricuspid Valve Disease

Belluschi, Igor; Forno, Benedetto Del; Lapenna, Elisabetta; Nisi, Teodora; Iaci, Giuseppe; Ferrara, David; Castiglioni, Alessandro; Alfieri, Ottavio; Bonis, Michele De

doi:10.3389/fcvm.2018.00118

Cited by 35 publications

(36 citation statements)

References 24 publications

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“…Currently, the surgical techniques for FTR vary from suture repair to implantation of prosthetic rings. Since the first introduction of prosthetic rings for tricuspid annuloplasty in 1971, multiple ring designs have been developed to reinforce the tricuspid annulus by fixing the annulus during systole, restoring the physiologic valve geometry, reducing the annular dilatation, or restoring the 3D morphology [4]. The prosthetic rings for tricuspid annuloplasty have been categorized in accordance with the degree of rigidity, the completeness of the circularity, and the dimensionality.…”

Section: Introductionmentioning

confidence: 99%

Outcome of MC3 ring annuloplasty for moderate and severe functional tricuspid regurgitation associated with rheumatic mitral valve disease

2019

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Background: To evaluate early and midterm outcomes of tricuspid ring annuloplasty using three-dimensional (3D) MC3 ring for treatment of functional tricuspid regurgitation (FTR) during mitral valve replacement for rheumatic valve disease. Results: This prospective study included 105 patients who underwent repair for ≥ moderate tricuspid regurgitation (TR) during mitral valve replacement for rheumatic valve disease. Between January 2016 and December 2018, a group of 23 patients who underwent ring annuloplasty with Edward MC3 rings was compared to another group of 82 patients who underwent standard suture (DeVega) repair. The primary outcome was residual TR (≥ moderate TR). During an average follow-up period of 18.84 ± 9.90 months (range 3-33 months), the preoperative grade of TR improved significantly in both groups. The postoperative mean of TR in the MC3 group was significantly lower than that in the DeVega group (0.17 ± 0.49 versus 0.77 ± 0.93, P = 0.004). The rate of TR recurrence (≥ 2+ TR) was significantly higher after MC3 ring annuloplasty (4.3% versus 23.1%, P = 0.03). Freedom from mild TR was 30.5% in the DeVega group and 61% in the ring annuloplasty group (P = 0.007). Freedom from residual TR was 76.8% in the DeVega group and 95.7% in the ring annuloplasty group (P = 0.04). Conclusions: The use of MC3 rings is a safe and effective alternative to DeVega repair for the management of FTR. However, further evaluation of long-term durability is recommended.

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Section: Introductionmentioning

confidence: 99%

Outcome of MC3 ring annuloplasty for moderate and severe functional tricuspid regurgitation associated with rheumatic mitral valve disease

2019

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“…This technique is employed when annuloplasty does not sufficiently correct FTR, such as cases of severe leaflet tethering. On the other hand, “the Clover Technique”, named for the post-operative shape of the valve, was developed by Lapenna et al (2010) and Belluschi et al (2018) [94,95] to correct severe FTR and significant leaflet tethering. The procedure uses both suture and ring annuloplasty to restore the annular geometry and a polypropylene suture to fasten each leaflet at the midpoint of the free edge.…”

Section: Functional Tricuspid Regurgitation: Diagnosis and Treatmementioning

confidence: 99%

Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling

et al. 2019

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Proper tricuspid valve (TV) function is essential to unidirectional blood flow through the right side of the heart. Alterations to the tricuspid valvular components, such as the TV annulus, may lead to functional tricuspid regurgitation (FTR), where the valve is unable to prevent undesired backflow of blood from the right ventricle into the right atrium during systole. Various treatment options are currently available for FTR; however, research for the tricuspid heart valve, functional tricuspid regurgitation, and the relevant treatment methodologies are limited due to the pervasive expectation among cardiac surgeons and cardiologists that FTR will naturally regress after repair of left-sided heart valve lesions. Recent studies have focused on (i) understanding the function of the TV and the initiation or progression of FTR using both in-vivo and in-vitro methods, (ii) quantifying the biomechanical properties of the tricuspid valve apparatus as well as its surrounding heart tissue, and (iii) performing computational modeling of the TV to provide new insight into its biomechanical and physiological function. This review paper focuses on these advances and summarizes recent research relevant to the TV within the scope of FTR. Moreover, this review also provides future perspectives and extensions critical to enhancing the current understanding of the functioning and remodeling tricuspid valve in both the healthy and pathophysiological states.

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“…The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy [16].…”

Section: Surgical Techniques For the Treatment Of Tricuspid Insufficimentioning

confidence: 99%

“…The annuloplasty technique with rigid or semi-rigid incomplete ring implants showed better results compared to sutures and is the most selected technique for annuloplasty. In some cases, the annuloplasty is not sufficient; therefore, it is necessary to increase the anterior leaflet with pericardium or the Clover technique (stitching together the middle point of the free edges of the tricuspid leaflets) [16, 19].…”

Section: Surgical Techniques For the Treatment Of Tricuspid Insufficimentioning

confidence: 99%

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The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming

Oliveira

Oliveira²

2019

Cardiol Res

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The tricuspid valve (TV) has been known as the forgotten valve. However, considering recent information from scientific studies, this nomenclature may need to be adjusted for the valve, which also needs to be better studied and understood. For decades, tricuspid regurgitation (TR) was not fully appreciated and was never the priority. However, studies have revealed that such pathology is related to a possible negative impact on prognosis of patients. Severe TR is a predictor of higher mortality. For the treatment of TR, repair or valve replacement can be performed. Repair techniques can be performed on the annulus (suture annuloplasty or ring implant), on the leaflets (e.g. triangular resection), on the cords (transfers or new cords) and on the papillary muscles (e.g. sliding technique). The anatomical characteristics of the TV determine the repair technique to be used. In some cases, valve repair is not possible and/or not indicated and valve replacement is selected based on the strategy. Nowadays transcatheter therapies have been used and studied. The main transcatheter strategies for the treatment of TR are based on reduction of the annulus (Cardioband, Trialign, TriCinch, Millipede and TRAIPTA), improvement of the leaflet coaptation (Mitraclip, FORMA device, PASCAL system, and TV occluder), reduction of the reflux for the vena cava system (Tric valve and Sapien valve implant), and valve implants (Navigate, Trisol, Sapien, Melody). In this context, there are still other devices (such as Tricentro, Pasta, etc.) being developed and tested throughout several phases of research. In the future, improved knowledge of the TV and the evolution of transcatheter treatments will alter the history of the TV. The transcatheter revolution is coming!

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Surgical Techniques for Tricuspid Valve Disease

Cited by 35 publications

References 24 publications

Outcome of MC3 ring annuloplasty for moderate and severe functional tricuspid regurgitation associated with rheumatic mitral valve disease

Outcome of MC3 ring annuloplasty for moderate and severe functional tricuspid regurgitation associated with rheumatic mitral valve disease

Mechanics of the Tricuspid Valve—From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling

The Forgotten, Not Studied or Not Valorized Tricuspid Valve: The Transcatheter Revolution Is Coming

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