Tricuspid Annuloplasty

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Robert J. Lederman - One of the best experts on this subject based on the ideXlab platform.

  • 600 66 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta first in human report
    Jacc-cardiovascular Interventions, 2019
    Co-Authors: Toby Rogers, Jaffar M Khan, Adam B Greenbaum, Dee Dee Wang, Vasilis Babaliaros, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation (TR) is a malignant disease with high surgical mortality. Pledget-Assisted Suture Tricuspid Annuloplasty (PASTA) is a percutaneous annular repair to create a double orifice Tricuspid valve using marketed equipment. An 83-year-old man with torrential defibrillator-lead

  • transcatheter pledget assisted suture Tricuspid Annuloplasty pasta to create a double orifice valve
    Catheterization and Cardiovascular Interventions, 2018
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Objectives Pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice Tricuspid valve. Background Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Methods Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the Tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice Tricuspid valve. Results Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm2 to 3.8 ± 1.5 cm2 (naive) and 13.1 ± 1.5 cm2 to 6.2 ± 1.0 cm2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naive) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naive) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived Tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P Conclusions PASTA reduces annular dimensions and Tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe Tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology.

  • tct 87 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta
    Journal of the American College of Cardiology, 2017
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. We propose a percutaneous pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) using marketed equipment. X-ray fluoroscopy and intracardiac

  • Transatrial intrapericardial Tricuspid Annuloplasty.
    JACC. Cardiovascular interventions, 2015
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Marcus Y. Chen, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    Abstract Objectives This study sought to demonstrate transcatheter deployment of a circumferential device within the pericardial space to modify Tricuspid annular dimensions interactively and to reduce functional Tricuspid regurgitation (TR) in swine. Background Functional TR is common and is associated with increased morbidity and mortality. There are no reported transcatheter Tricuspid valve repairs. We describe a transcatheter extracardiac Tricuspid Annuloplasty device positioned in the pericardial space and delivered by puncture through the right atrial appendage. We demonstrate acute and chronic feasibility in swine. Methods Transatrial intrapericardial Tricuspid Annuloplasty (TRAIPTA) was performed in 16 Yorkshire swine, including 4 with functional TR. Invasive hemodynamics and cardiac magnetic resonance imaging (MRI) were performed at baseline, immediately after Annuloplasty and at follow-up. Results Pericardial access via a right atrial appendage puncture was uncomplicated. In 9 naive animals, Tricuspid septal-lateral and anteroposterior dimensions, the annular area and perimeter, were reduced by 49%, 31%, 59%, and 24% (p  Conclusions Transatrial intrapericardial Tricuspid Annuloplasty is a transcatheter extracardiac Tricuspid valve repair performed by exiting the heart from within via a transatrial puncture. The geometry of the Tricuspid annulus can interactively be modified to reduce severity of functional TR in an animal model.

  • crt 823 transcatheter extra cardiac Tricuspid Annuloplasty
    Jacc-cardiovascular Interventions, 2015
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Marcus Y. Chen, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    We designed and built a device that is positioned along the atrioventricular groove in the pericardial space and tightened to modify the geometry of the Tricuspid annulus to treat functional Tricuspid regurgitation. The device is delivered to the pericardial space from within via trans-atrial

Toby Rogers - One of the best experts on this subject based on the ideXlab platform.

  • 600 66 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta first in human report
    Jacc-cardiovascular Interventions, 2019
    Co-Authors: Toby Rogers, Jaffar M Khan, Adam B Greenbaum, Dee Dee Wang, Vasilis Babaliaros, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation (TR) is a malignant disease with high surgical mortality. Pledget-Assisted Suture Tricuspid Annuloplasty (PASTA) is a percutaneous annular repair to create a double orifice Tricuspid valve using marketed equipment. An 83-year-old man with torrential defibrillator-lead

  • transcatheter pledget assisted suture Tricuspid Annuloplasty pasta to create a double orifice valve
    Catheterization and Cardiovascular Interventions, 2018
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Objectives Pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice Tricuspid valve. Background Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Methods Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the Tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice Tricuspid valve. Results Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm2 to 3.8 ± 1.5 cm2 (naive) and 13.1 ± 1.5 cm2 to 6.2 ± 1.0 cm2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naive) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naive) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived Tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P Conclusions PASTA reduces annular dimensions and Tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe Tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology.

  • tct 87 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta
    Journal of the American College of Cardiology, 2017
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. We propose a percutaneous pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) using marketed equipment. X-ray fluoroscopy and intracardiac

  • Transatrial intrapericardial Tricuspid Annuloplasty.
    JACC. Cardiovascular interventions, 2015
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Marcus Y. Chen, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    Abstract Objectives This study sought to demonstrate transcatheter deployment of a circumferential device within the pericardial space to modify Tricuspid annular dimensions interactively and to reduce functional Tricuspid regurgitation (TR) in swine. Background Functional TR is common and is associated with increased morbidity and mortality. There are no reported transcatheter Tricuspid valve repairs. We describe a transcatheter extracardiac Tricuspid Annuloplasty device positioned in the pericardial space and delivered by puncture through the right atrial appendage. We demonstrate acute and chronic feasibility in swine. Methods Transatrial intrapericardial Tricuspid Annuloplasty (TRAIPTA) was performed in 16 Yorkshire swine, including 4 with functional TR. Invasive hemodynamics and cardiac magnetic resonance imaging (MRI) were performed at baseline, immediately after Annuloplasty and at follow-up. Results Pericardial access via a right atrial appendage puncture was uncomplicated. In 9 naive animals, Tricuspid septal-lateral and anteroposterior dimensions, the annular area and perimeter, were reduced by 49%, 31%, 59%, and 24% (p  Conclusions Transatrial intrapericardial Tricuspid Annuloplasty is a transcatheter extracardiac Tricuspid valve repair performed by exiting the heart from within via a transatrial puncture. The geometry of the Tricuspid annulus can interactively be modified to reduce severity of functional TR in an animal model.

  • crt 823 transcatheter extra cardiac Tricuspid Annuloplasty
    Jacc-cardiovascular Interventions, 2015
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Marcus Y. Chen, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    We designed and built a device that is positioned along the atrioventricular groove in the pericardial space and tightened to modify the geometry of the Tricuspid annulus to treat functional Tricuspid regurgitation. The device is delivered to the pericardial space from within via trans-atrial

Jaffar M Khan - One of the best experts on this subject based on the ideXlab platform.

  • 600 66 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta first in human report
    Jacc-cardiovascular Interventions, 2019
    Co-Authors: Toby Rogers, Jaffar M Khan, Adam B Greenbaum, Dee Dee Wang, Vasilis Babaliaros, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation (TR) is a malignant disease with high surgical mortality. Pledget-Assisted Suture Tricuspid Annuloplasty (PASTA) is a percutaneous annular repair to create a double orifice Tricuspid valve using marketed equipment. An 83-year-old man with torrential defibrillator-lead

  • transcatheter pledget assisted suture Tricuspid Annuloplasty pasta to create a double orifice valve
    Catheterization and Cardiovascular Interventions, 2018
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Objectives Pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice Tricuspid valve. Background Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Methods Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the Tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice Tricuspid valve. Results Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm2 to 3.8 ± 1.5 cm2 (naive) and 13.1 ± 1.5 cm2 to 6.2 ± 1.0 cm2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naive) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naive) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived Tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P Conclusions PASTA reduces annular dimensions and Tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe Tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology.

  • tct 87 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta
    Journal of the American College of Cardiology, 2017
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. We propose a percutaneous pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) using marketed equipment. X-ray fluoroscopy and intracardiac

William H. Schenke - One of the best experts on this subject based on the ideXlab platform.

  • transcatheter pledget assisted suture Tricuspid Annuloplasty pasta to create a double orifice valve
    Catheterization and Cardiovascular Interventions, 2018
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Objectives Pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice Tricuspid valve. Background Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Methods Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the Tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice Tricuspid valve. Results Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm2 to 3.8 ± 1.5 cm2 (naive) and 13.1 ± 1.5 cm2 to 6.2 ± 1.0 cm2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naive) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naive) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived Tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P Conclusions PASTA reduces annular dimensions and Tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe Tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology.

  • tct 87 transcatheter pledget assisted suture Tricuspid Annuloplasty pasta
    Journal of the American College of Cardiology, 2017
    Co-Authors: Jaffar M Khan, Toby Rogers, William H. Schenke, Marcus Y. Chen, Adam B Greenbaum, Vasilis Babaliaros, Gaetano Paone, Rajiv Ramasawmy, Daniel A Herzka, Robert J. Lederman
    Abstract:

    Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. We propose a percutaneous pledget-assisted suture Tricuspid valve Annuloplasty (PASTA) using marketed equipment. X-ray fluoroscopy and intracardiac

  • Transatrial intrapericardial Tricuspid Annuloplasty.
    JACC. Cardiovascular interventions, 2015
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Marcus Y. Chen, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    Abstract Objectives This study sought to demonstrate transcatheter deployment of a circumferential device within the pericardial space to modify Tricuspid annular dimensions interactively and to reduce functional Tricuspid regurgitation (TR) in swine. Background Functional TR is common and is associated with increased morbidity and mortality. There are no reported transcatheter Tricuspid valve repairs. We describe a transcatheter extracardiac Tricuspid Annuloplasty device positioned in the pericardial space and delivered by puncture through the right atrial appendage. We demonstrate acute and chronic feasibility in swine. Methods Transatrial intrapericardial Tricuspid Annuloplasty (TRAIPTA) was performed in 16 Yorkshire swine, including 4 with functional TR. Invasive hemodynamics and cardiac magnetic resonance imaging (MRI) were performed at baseline, immediately after Annuloplasty and at follow-up. Results Pericardial access via a right atrial appendage puncture was uncomplicated. In 9 naive animals, Tricuspid septal-lateral and anteroposterior dimensions, the annular area and perimeter, were reduced by 49%, 31%, 59%, and 24% (p  Conclusions Transatrial intrapericardial Tricuspid Annuloplasty is a transcatheter extracardiac Tricuspid valve repair performed by exiting the heart from within via a transatrial puncture. The geometry of the Tricuspid annulus can interactively be modified to reduce severity of functional TR in an animal model.

  • crt 823 transcatheter extra cardiac Tricuspid Annuloplasty
    Jacc-cardiovascular Interventions, 2015
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Marcus Y. Chen, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    We designed and built a device that is positioned along the atrioventricular groove in the pericardial space and tightened to modify the geometry of the Tricuspid annulus to treat functional Tricuspid regurgitation. The device is delivered to the pericardial space from within via trans-atrial

  • tct 127 trans auricular intra pericardial Tricuspid Annuloplasty traipta
    Journal of the American College of Cardiology, 2013
    Co-Authors: Toby Rogers, Kanishka Ratnayaka, Merdim Sonmez, Dominique N. Franson, William H. Schenke, Anthony Z. Faranesh, Robert J. Lederman
    Abstract:

    Functional Tricuspid regurgitation (TR) is clinically significant. TR predicts mortality independent of LVEF, age or pulmonary artery pressure. Persistent TR after mitral valve surgery is an independent poor prognostic sign. Tricuspid valve repair is usually an adjunct to other surgery. We present

Muralidhar Padala - One of the best experts on this subject based on the ideXlab platform.

  • hemodynamic outcomes after undersizing ring Annuloplasty and focal suture Annuloplasty for surgical repair of functional Tricuspid regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Alan Amedi, Daisuke Onohara, Kirthana Sreerangathama Suresh, Muralidhar Padala
    Abstract:

    OBJECTIVE Surgical Annuloplasty for functional Tricuspid regurgitation (FTR) is on the rise and can be performed in several ways with varied outcomes. In this study, we sought to compare the hemodynamic outcomes of Tricuspid Annuloplasty performed with a commercially available Annuloplasty ring (Tricuspid valve Annuloplasty [TVA]) compared with focal suture Annuloplasty (Hetzer) in an experimental FTR model. METHODS An ex vivo FTR model was developed by inducing right ventricular dilatation by acute afterload elevation, causing severe Tricuspid valve tethering and annular dilatation, leading to regurgitation. Ten porcine hearts in which FTR was induced underwent TVA with a 26-mm Edwards MC3 ring and Hetzer Annuloplasty with a pledgeted suture cinching the anteroposterior and septal annulus. FTR was measured before after each repair, and tenting geometry, valve kinematics, and subvalvular geometry were measured with echocardiography. RESULTS At baseline, none of the hearts had FTR, but upon afterload elevation an FTR volume of 17.7 ± 9.2 mL (26.38 ± 17.47% regurgitant fraction) was measured (P < .0001). TVA reduced regurgitation by 50% and Hetzer Annuloplasty by 56% , respectively, but both left persistent FTR. Anteroseptal tenting area was 279.0 ± 158.9 mm2 before repair and decreased significantly to 147.2 ± 134.8 mm2 (P = .0195) with Hetzer but not with TVA. Posteroseptal tenting area was 425.1 ± 169.2 mm2 before repair and was significantly reduced by both techniques (TVA: 200.3 ± 102.9 mm2 [P = .0012]; Hetzer: 237.6 ± 127.6 mm2 [P = .0270]). CONCLUSIONS Tricuspid Annuloplasty with a ring or a focal suture can reduce FTR but not eliminate it. Annular approaches did not relieve Tricuspid valve tethering and reduced leaflet mobility persisted. Either subannular repairs or judicious use of valve replacement may be necessary.

  • hemodynamic outcomes after undersizing ring Annuloplasty and focal suture Annuloplasty for surgical repair of functional Tricuspid regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Alan Amedi, Daisuke Onohara, Kirthana Sreerangathama Suresh, Muralidhar Padala
    Abstract:

    Abstract Objective Surgical Annuloplasty for functional Tricuspid regurgitation (FTR) is on the rise and can be performed in several ways with varied outcomes. In this study, we sought to compare the hemodynamic outcomes of Tricuspid Annuloplasty performed with a commercially available Annuloplasty ring (Tricuspid valve Annuloplasty [TVA]) compared with focal suture Annuloplasty (Hetzer) in an experimental FTR model. Methods An ex vivo FTR model was developed by inducing right ventricular dilatation by acute afterload elevation, causing severe Tricuspid valve tethering and annular dilatation, leading to regurgitation. Ten porcine hearts in which FTR was induced underwent TVA with a 26-mm Edwards MC3 ring and Hetzer Annuloplasty with a pledgeted suture cinching the anteroposterior and septal annulus. FTR was measured before after each repair, and tenting geometry, valve kinematics, and subvalvular geometry were measured with echocardiography. Results At baseline, none of the hearts had FTR, but upon afterload elevation an FTR volume of 17.7 ± 9.2 mL (26.38 ± 17.47% regurgitant fraction) was measured (P  Conclusions Tricuspid Annuloplasty with a ring or a focal suture can reduce FTR but not eliminate it. Annular approaches did not relieve Tricuspid valve tethering and reduced leaflet mobility persisted. Either subannular repairs or judicious use of valve replacement may be necessary.

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