BACKGROUND: Tricuspid valve (TV) ring annuloplasty provides excellent results for the treatment of mild or moderate Tricuspid Regurgitation (TR) due to annular dilatation. However, there is a 15—30% recurrence rate of following tricuspid ring annuloplasty for severe TR, with severe leaflet tethering particularly in cases of non-enlarged tricuspid annulus.
We describe a Tricuspid Valve Pericardial Leaflet Augmentation repair technique to treat severe TR in cases of severe leaflet tethering and small TV annulus.
METHODS: Between December 2011 and June 2013
we successfully performed this operation in 13 female patients with severe TR due to severe leaflet tethering (a tethering height greater than 8 mm) achieving complete elimination of TR with good coaptation of the tricuspid leaflets. Mean age was 60 ± 11years. 10 patients (77%) presented preoperatively with severe TR and 3 had moderate + TR. Preoperative Ejection Fraction (EF) was 59 ± 5%, mean NYHA class was 2.6±0.7. Twelve patients (92 %) underwent concomitant MV, AV, CABG or Maze procedure.
RESULTS: All patients had no TR at the end of the operation and a coaptation length of at least 7-8 mm was achieved in all cases. The tethering height remained unchanged with increased coaptation occurring within the RV. Follow-up of 1 to 21 months is available for 12 (92%) of whom 10 (83%) of whom were in NYHA class I or II and no patient had more than a trace TR.
CONCLUSIONS: TV anterior leaflet pericardial augmentation provides safe and effective method to treat severe TR in cases of severe leaflet tethering and small TV annulus
While early results are promising, long-term follow-up is warranted.
