Tricuspid Valve Repair

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Robert B Smith - One of the best experts on this subject based on the ideXlab platform.

Philip Green - One of the best experts on this subject based on the ideXlab platform.

Joseph A Dearani - One of the best experts on this subject based on the ideXlab platform.

  • Strategies for Tricuspid Valve Repair.
    Indian journal of thoracic and cardiovascular surgery, 2019
    Co-Authors: Nishant Saran, Joseph A Dearani
    Abstract:

    Tricuspid Valve Repair is in many ways more challenging than mitral Valve Repair, especially since Tricuspid Valve anatomy is more complex with three leaflets, a saddle-shaped dynamic annulus and a complex subvalvular apparatus. The late referral of patients for Tricuspid Valve surgery adds to this challenge and contributes to poor prognosis. Nevertheless, studies have shown that the presence of moderate or greater Tricuspid Valve regurgitation leads to poor survival. Consequently, Tricuspid Valve surgery is now being performed more often, in order to improve the quality of life and survival. Tricuspid Valve disease can be broadly classified into congenital and acquired Tricuspid Valve pathologies. Various Repair techniques besides simple annular reduction maneuvers are used which are primarily aimed at restoring the complex interplay of various anatomical components. This review is a summary of the various operative techniques which provide successful reproducible results and achieve a competent and durable Tricuspid Valve Repair with satisfactory late outcomes.

  • outcomes of ring versus suture annuloplasty for Tricuspid Valve Repair in patients undergoing mitral Valve surgery
    The Journal of Thoracic and Cardiovascular Surgery, 2016
    Co-Authors: Sung Ho Shinn, Joseph A Dearani, Victor Dayan, Hartzell V Schaff, Lyle D Joyce, Brian D Lahr, Kevin L Greason, John M Stulak, Richard C. Daly
    Abstract:

    Abstract Objective There is controversy regarding the comparative effectiveness of methods of Tricuspid Valve (TV) Repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral Valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent Tricuspid regurgitation (TR) following TV Repair and focused on results stratified by method of Tricuspid Valve Repair. Methods We reviewed patients who underwent TV Repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic Valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. Results In the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers ( P  = .05), lower ejection fractions ( P  = .028), and more recent years of operation ( P P  = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up ( P  = .857). Conclusions Late survival and TV durability following concomitant TV Repair during MV surgery did not differ with respect to TV Repair technique. In this series of patients with Repaired Tricuspid Valves, etiology of MV disease did not influence postoperative changes in TR.

  • Tricuspid Valve Repair for ebstein s anomaly in young children a 30 year experience
    The Annals of Thoracic Surgery, 2006
    Co-Authors: Umar S. Boston, Joseph A Dearani, David J. Driscoll, Patrick W Oleary, Gordon K. Danielson
    Abstract:

    Background The purpose of this study was to examine early and late outcome of Tricuspid Valve Repair for Ebstein's anomaly in young children. Methods Between October 1974 and November 2003, 52 children (25 boys) underwent Tricuspid Valve Repair and annuloplasty for Ebstein's anomaly. Mean age was 7.1 ± 3.9 years (range, 5 months to 12 years). Concomitant procedures included atrial septal defect closure (n = 46), division of accessory conduction pathways (n = 4), ventricular septal defect closure (n = 3), and other (n = 7). Results Early mortality was 5.8% (3 of 52 patients; no mortality since 1984, n=31). Risk factors were age younger than 2.5 years ( p = 0.03) and weight less than 10.7 kg ( p = 0.03). Morbidity included transient atrial (n = 11) and ventricular arrhythmias (n = 5), and early reoperation in 3 patients. There was no need for a permanent pacemaker. Mean follow-up was 12.2 ± 7.4 years (maximum, 24.3 years). Actuarial survival at 5, 10, and 15 years was 92.3% ± 3.7%, 89.9% ± 4.3%, and 89.9% ± 4.3%, respectively. Freedom from all reoperations at 5, 10, and 15 years was 91.0% ± 4.3%, 76.9% ± 6.8%, and 61.4% ± 8.8%, respectively. Moderate (grade II) or more Tricuspid regurgitation on dismissal echocardiogram was the only risk factor for reoperation ( p = 0.04). Tricuspid stenosis did not occur in any patient. At late follow-up, 89% of patients were in New York Heart Association class I or II. Conclusions Ebstein's anomaly in young children can now be Repaired with low mortality and good Tricuspid Valve durability. Tricuspid regurgitation at the completion of operation should be mild or less to minimize need for reoperation. Tricuspid Valve Repair and annuloplasty did not result in stenosis despite somatic growth. Most patients enjoy an excellent quality of life.

  • Tricuspid Valve Repair for Ebstein’s Anomaly in Young Children: A 30-Year Experience
    The Annals of thoracic surgery, 2006
    Co-Authors: Umar S. Boston, Joseph A Dearani, Patrick W. O'leary, David J. Driscoll, Gordon K. Danielson
    Abstract:

    Background The purpose of this study was to examine early and late outcome of Tricuspid Valve Repair for Ebstein's anomaly in young children. Methods Between October 1974 and November 2003, 52 children (25 boys) underwent Tricuspid Valve Repair and annuloplasty for Ebstein's anomaly. Mean age was 7.1 ± 3.9 years (range, 5 months to 12 years). Concomitant procedures included atrial septal defect closure (n = 46), division of accessory conduction pathways (n = 4), ventricular septal defect closure (n = 3), and other (n = 7). Results Early mortality was 5.8% (3 of 52 patients; no mortality since 1984, n=31). Risk factors were age younger than 2.5 years ( p = 0.03) and weight less than 10.7 kg ( p = 0.03). Morbidity included transient atrial (n = 11) and ventricular arrhythmias (n = 5), and early reoperation in 3 patients. There was no need for a permanent pacemaker. Mean follow-up was 12.2 ± 7.4 years (maximum, 24.3 years). Actuarial survival at 5, 10, and 15 years was 92.3% ± 3.7%, 89.9% ± 4.3%, and 89.9% ± 4.3%, respectively. Freedom from all reoperations at 5, 10, and 15 years was 91.0% ± 4.3%, 76.9% ± 6.8%, and 61.4% ± 8.8%, respectively. Moderate (grade II) or more Tricuspid regurgitation on dismissal echocardiogram was the only risk factor for reoperation ( p = 0.04). Tricuspid stenosis did not occur in any patient. At late follow-up, 89% of patients were in New York Heart Association class I or II. Conclusions Ebstein's anomaly in young children can now be Repaired with low mortality and good Tricuspid Valve durability. Tricuspid regurgitation at the completion of operation should be mild or less to minimize need for reoperation. Tricuspid Valve Repair and annuloplasty did not result in stenosis despite somatic growth. Most patients enjoy an excellent quality of life.

  • Mitral and Tricuspid Valve Repair in patients with previous mediastinal radiation therapy.
    The Annals of thoracic surgery, 2004
    Co-Authors: Juan A. Crestanello, Joseph A Dearani, Gordon K. Danielson, Christopher G.a. Mcgregor, Richard C. Daly, Thomas A. Orszulak, Charles J. Mullany, Francisco J. Puga, Kenton J. Zehr, Cathy D. Schleck
    Abstract:

    Abstract Background The purpose of this study was to evaluate outcomes of mitral and Tricuspid Valve Repair after mediastinal radiation therapy. Methods From 1976 to 2001, 22 patients (mean age 61 ± 14 years) underwent mitral (n = 14), Tricuspid (n = 6), or both (n = 2) Valve Repairs 15 ± 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; Valve replacement, 6 patients (4 aortic, 3 mitral, 1 Tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients. Results Total follow-up was 82.5 patient-years (mean 3.7 ± 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent Valve replacements, and 1 required cardiac transplantation 3.4 ± 2.8 years after Valve Repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their Repaired Valve function. Overall survival, freedom from cardiac death, and freedom from Valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors. Conclusions Functional status was good in two-thirds of late survivors. However, severe dysfunction of the Repaired Valve developed in 32% of early survivors and 16% required further surgery. Valve Repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of Repairs after mediastinal radiation in this series suggests that Valve replacement might be preferable.

Michael A. Borger - One of the best experts on this subject based on the ideXlab platform.

  • Aetiology‐based clinical scenarios predict outcomes of transcatheter edge‐to‐edge Tricuspid Valve Repair of functional Tricuspid regurgitation
    European journal of heart failure, 2019
    Co-Authors: Florian Schlotter, Mathias Orban, Karl-philipp Rommel, Christian Besler, Maximilian Von Roeder, Daniel Braun, Matthias Unterhuber, Michael A. Borger, Christian Hagl, Martin Orban
    Abstract:

    Transcatheter Tricuspid Valve Repair (TTVR) is an emerging technique to treat Tricuspid regurgitation (TR). Predictors of adverse outcomes are scarce, and stratification by TR aetiologies is lacking.

  • increased risk of dehiscence after Tricuspid Valve Repair with rigid annuloplasty rings
    The Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: B Pfannmuller, Michael A. Borger, Torsten Doenst, Katja Eberhardt, J Seeburger, Friedrich W Mohr
    Abstract:

    Objectives Surgical management of Tricuspid Valve regurgitation mainly consists of Tricuspid Valve annuloplasty, usually performed with implantation of a rigid ring or a flexible band. Methods We performed a retrospective analysis on 820 patients who underwent Tricuspid Valve Repair between March 2002 and July 2009 with either a flexible Cosgrove-Edwards band (n = 415; Edwards Lifesciences LLC, Irvine, Calif) or a rigid Carpentier-Edwards Classic annuloplasty ring (n = 405; Edwards Lifesciences). Mean patient age was 69.2 ± 9.5 years, 54.1% were female, and average logistic EuroSCORE was 13.3% ± 12.5%. Concomitant procedures were performed in 94.6% of patients (mitral Valve surgery, 80.6%; aortic Valve surgery, 28.2%; coronary artery bypass grafting, 24.5%; atrial fibrillation ablation, 44.5%). One fifth of the operations were reoperative procedures. Follow-up was 94% complete, with mean duration of 21.0 ± 19.0 months. Results Thirty-day mortality was 10.1% (Cosgrove-Edwards, 11.9%; Carpentier-Edwards, 8.4%), and 5-year survival was 62.4% (Carpentier-Edwards, 64.7%; Cosgrove-Edwards, 60.3%). Postoperative echocardiography showed significant improvement in Tricuspid Valve function, with reduction in Tricuspid regurgitation grade from 2.3 ± 0.7 to 0.7 ± 0.7, and no differences between groups. Use of a Carpentier-Edwards ring, however, was associated with significantly higher risk of dehiscence (Carpentier-Edwards, 8.7%; Cosgrove-Edwards, 0.9%; P P P Conclusions Although both rigid and flexible systems provide acceptable early Tricuspid Valve Repair results, use of a rigid ring increases risk of subsequent ring dehiscence.

  • midterm outcomes of Tricuspid Valve Repair versus replacement for organic Tricuspid disease
    The Annals of Thoracic Surgery, 2006
    Co-Authors: Steve K. Singh, Gilbert H.l. Tang, Michael A. Borger, Manjula Maganti, Susan Armstrong, William G Williams, Tirone E David
    Abstract:

    Background Organic Tricuspid Valve (TV) disease is uncommon. Few studies have compared TV Repair with replacement in these patients. The current study compared midterm outcomes of TV Repair versus replacement in a large group of patients with organic Tricuspid disease. Methods Two-hundred and fifty patients underwent surgery for organic TV disease at our institution from 1979 to 2003. Clinical and echocardiographic follow-up were obtained, were 99% complete, and were 5.2 ± 4.1 years long (mean ± standard deviation). Results One hundred and seventy-eight patients (71%) underwent TV Repair and 72 (29%) received TV replacement (54 bioprosthetic, 18 mechanical). Repair patients were more likely to have hypertension, rheumatic pathology, or elective surgery. Concomitant procedures included mitral (50% of patients), aortic (26%), and coronary bypass (6%) operations. Perioperative and midterm mortality were higher in the replacement group (both p p p = 0.02). Follow-up echocardiography revealed more moderate to severe Tricuspid regurgitation in Repair patients (38% vs 5%, p Conclusions Tricuspid Valve Repair is associated with better perioperative, midterm, and event-free survival than TV replacement in patients with organic Tricuspid disease. Despite more Tricuspid regurgitation in the Repair group during follow-up, reoperation rates and functional class were similar. Repair should be performed whenever possible in patients with organic Tricuspid disease.

  • Tricuspid Valve Repair with an annuloplasty ring results in improved long-term outcomes.
    Circulation, 2006
    Co-Authors: Gilbert H.l. Tang, Steve K. Singh, Susan Armstrong, Tirone E David, Manjula D Maganti, Michael A. Borger
    Abstract:

    The purpose of this study was to compare the long-term results of Tricuspid Valve (TV) Repair with or without an annuloplasty ring. 702 patients underwent TV Repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral Valve surgery in 80% of patients, aortic Valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow-up was 99% complete and was 5.9+/-4.9 (mean+/-SD) years long. Ring patients were younger (55+/-14 versus 59+/-14 years; P=0.001) and less likely to have coronary artery disease (10% versus 17%; P=0.02), more likely to be female (75% versus 65%; P=0.01) and having had previous cardiac surgery (56% versus 42%; P=0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P=0.03) and event-free survival (HR, 0.8; CI, 0.6 to 1.0; P=0.04). Placement of an annuloplasty ring in patients undergoing Tricuspid Valve Repair is associated with improved survival and event-free survival.

  • Tricuspid Valve Repair with an annuloplasty ring results in improved long term outcomes
    Circulation, 2006
    Co-Authors: Gilbert H.l. Tang, Steve K. Singh, Manjula Maganti, Susan Armstrong, Tirone E David, Michael A. Borger
    Abstract:

    Background— The purpose of this study was to compare the long-term results of Tricuspid Valve (TV) Repair with or without an annuloplasty ring. Methods and Results— 702 patients underwent TV Repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral Valve surgery in 80% of patients, aortic Valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow-up was 99% complete and was 5.9±4.9 (mean±SD) years long. Ring patients were younger (55±14 versus 59±14 years; P =0.001) and less likely to have coronary artery disease (10% versus 17%; P =0.02), more likely to be female (75% versus 65%; P =0.01) and having had previous cardiac surgery (56% versus 42%; P =0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P =0.03) and event-free survival (HR, 0.8; CI, 0.6 to 1.0; P =0.04). Conclusions— Placement of an annuloplasty ring in patients undergoing Tricuspid Valve Repair is associated with improved survival and event-free survival.

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

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