Repair versus replacement: a meta-analysis on the efficacy of isolated tricuspid valve surgery / 中华胸心血管外科杂志

Objective:We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement.Methods:We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP database and WanFang database from the inception to September 30, 2021 for studies reporting outcomes of both isolated tricuspid valve repair and replacement, excluding congenital tricuspid aetiologies. Data were extracted and pooled using random-effects models and Review Manager 5.3 software.Results:A total of 18 articles were included, covering 10 023 patients, totalling 4 749 repairs and 5 274 replacements. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs. 9.9%, OR=0.64(0.44, 0.93). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs. 15.6%, OR=0.81(0.72, 0.92) and pacemaker implantation 7.9% vs. 26.4%, OR=0.24 (0.21, 0.30). There were no differences in rates of hospital stroke 14.4% vs. 10.3% , OR = 1.41 (0.98, 2.04) and late mortality rates 13.9% vs. 16.1%, OR=0.91(0.49, 1.69). Conclusion:Isolated tricuspid valve repair is associated with significantly reduced in-hospital mortality, renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease.

A Case of Tricuspid Valve Endocarditis with Systemic Embolization of Vegetation via a Patent Foramen Ovale / 日本心臓血管外科学会雑誌

A 28-year-old woman with patent foramen ovale who developed tricuspid valve infective endocarditis with complications of multiple infarctions and abscesses was treated surgically. The patient was transferred to our institution because of fever and joint pain. Echocardiography revealed a large vegetation (25 mm) on the tricuspid valve and a patent foramen ovale. Computed tomography and magnetic resonance imaging showed cerebral infarctions, multiple lung abscesses, and vertebral osteomyelitis. <i>Staphylococcus epidermidis </i>was identified in blood cultures. After treatment with adequate antibiotics for 5 weeks, the patient underwent surgical resection of the vegetation followed by tricuspid valve repair and direct closure of the patent foramen ovale. Antibiotic therapy was continued postoperatively, and the patient was discharged 7 weeks after the operation. No further endocarditis or embolism has occurred. In cases of right-sided endocarditis with systemic embolism and abscesses, the presence of a patent foramen ovale should be considered, and appropriate timing of the operation should be determined to prevent further systemic embolization of the vegetation.

Tricuspid Valve Re-Repair in Ebstein Anomaly Using the Cone Technique

The management of recurrent tricuspid regurgitation after tricuspid valve repair in patients with Ebstein anomaly is difficult, and tricuspid valve replacement is most commonly performed in such patients. We report two cases of recurrent tricuspid regurgitation in patients with Ebstein anomaly that were successfully re-repaired using the cone technique. The cone repair technique is a useful surgical method for reconstructing a competent tricuspid valve, and can be applied in patients who have undergone previous tricuspid valve repair.

Successful Repair of Critical Tricuspid Regurgitation Secondary to a Ruptured Papillary Muscle in a Neonate

Severe tricuspid regurgitation resulting from a flail leaflet is a rare cause of neonatal cyanosis. We report a neonate with profound cyanosis and severe tricuspid regurgitation caused by a rupture of the papillary muscle supporting the anterior leaflet, without other structural heart defects. Ductal patency could not be established. The repair of the tricuspid valve was performed after initial stabilization by using extracorporeal membrane oxygenation.

Quadrangular Resection of the Tricuspid Valve

Quadrangular resection is the gold standard technique for correction of the posterior leaflet prolapse in mitral valve disease. Prompted by the idea that the anterior leaflet of the tricuspid valve corresponds to the posterior leaflet of the mitral valve in its structure and function, we conducted a quadrangular resection of the anterior leaflet of the tricuspid valve in a case of tricuspid endocarditis. Tricuspid regurgitation was well corrected, and the durability of the repair was proven by the patient's freedom from cardiac events for the following 8 years.

Tricuspid Valve Surgery for Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome / 日本心臓血管外科学会雑誌

We reviewed our experience of tricuspid valve surgery for tricuspid regurgitation in hypoplastic left heart syndrome (HLHS) in terms of surgical timing, surgical procedures and long-term results. From May 1991 to July 2010, 105 classic HLHS patients underwent cardiac surgery, 28 of whom underwent a total of 31 tricuspid valve surgical procedures. Tricuspid valve surgery was performed in cases of moderate or more tricuspid regurgitation (TR). Type of the first tricuspid valve surgery was as follows : Annuloplasty in 15 patients, annuloplasty+commissure closure in 7 patients, commissure closure in 2 patients, edge-to-edge repair in 2 patients, tricuspid valve replacement in 2 patients. Three patients underwent re-operation because of progression of TR. Two of them underwent tricuspid valve repair and one of them underwent tricuspid valve replacement. Follow-up was 60.1±53.0 months. Freedom from moderate or more TR after tricuspid valve surgery was 50.9% at 1 year, 42.0% at 3 years, 36.0% at 5 years. Among 17 patients who achieved total cavopulmonary connection procedure, 35.2% of patients had moderate or more TR, but central venous pressure (9.1±2.2 mmHg), cardiac index (3.5±6.8 <i>l</i>/min/m²), arterial oxygen saturation (94.2±1.7%) showed as good hemodynamics after a Fontan procedure as non-tricuspid valve surgery cases. Appropriately timed aggressive tricuspid valve surgery yielded as good long-term results as HLHS without tricuspid valve surgery.

Cone Reconstruction for Tricuspid Valve Repair in a Patient with Ebstein's Anomaly : A case report / 대한흉부외과학회지

Ebstein's anomaly is a complex congenital defect of the tricuspid valve and right ventricle. Various surgical methods to repair the regurgitant tricuspid valve have been reported, and most of them depend on monocuspidalization with using the anterior leaflet. We report here on our first experience with Ebstein's anomaly in a 31-year-old female patient who underwent cone reconstruction of the tricuspid valve with using three leaflets.

Tricuspid Valve Repair for Tricuspid Valve Insufficiency Following a Cardiac Stab Injury / 대한흉부외과학회지

A 51-year-old male was admitted three month previously with a cardiac stab injury and he underwent direct cardiac repair. He had no problem after this event. He complained of dyspnea that started 2 months after the original injury. Echocardiography showed severe tricuspid regurgitation and so, chordac replacement and ring annuloplasty was performed. Herein we report on a case of tricuspid valve repair for treating tricuspid insufficiency following a cardiac stab injury.

Hetzer Technique for Surgical Correction of Ebstein's Anomaly / 대한흉부외과학회지

BACKGROUND: The Hetzer procedure for the correction of Ebstein's anomaly has the advantages of technical feasibility and incorporation of the atrialized right ventricle (RV) into the functional RV. MATERIAL AND METHOD: We preformed a retrospective review of 11 patients with Ebstein's anomaly and they had undergone a Hetzer procedure between March 2002 and December 2006. RESULT: The median age at operation was 19.8 years (range: 6 months~56 years). There were 4 males and 7 females. All patients showed severe tricuspid regurgitation (TR) preoperatively, and arterial desaturation (<95%) was present in 3 patients. The original Hetzer technique was employed in 6 patients with the Carpentier type A anomaly. In the remaining 5 patients with the Carpentier type B or C anomalies, valve competence was restored at the level of the displaced tricuspid valve mechanism. Adjunct bidirectional cavo-pulmonary shunt, or one and a half ventricle repair strategy was employed for all the patients. The median follow-up was 8.6 months (range: 0.8~51.9 months). There was no early or late death, and the immediate postoperative TR was trivial to mild in 8 patients. The median cardio-thoracic ratios on chest X-ray at the preoperative period and at postoperative 0, 1 and 6 months were 65%, 62%, 55% and 55%, respectively. CONCLUSION: The original or modified Hetzer procedure for Ebstein's anomaly shows excellent intermediate-term outcomes.

Three-dimensional Reconstruction of Tricuspid Annulus with the Duran Ring / 대한흉부외과학회지

Tricuspid annuloplasty with the flexible Duran ring may result in a physiologic repair while maintaining the dynamic morphology of the tricuspid annulus. A method for a durable three-dimensional tricuspid annular reconstruction, which retains the plasticity and orifice area of the tricuspid annulus, is described.

Early and Mid-term Results for Repair of Ebstein's Anomaly / 대한흉부외과학회지

BACKGROUND: We evaluated the early and mid-term results for repair of Ebstein's anomaly. MATERIAL AND METHOD: Between January 1989 and June 2004, 29 patients underwent repair of Ebstein's anomaly. The median age was 11.4 years (4 days-50 years). Tricuspid insufficiency equal to or greater than grade 3 was present in 21 (72.4%) patients. Surgical techniques included tricuspid valve repair with vertical plication of the atrialized ventricle (n=14), Carpentier's technique (n=7), tricuspid valve replacement (n=4), systemic-to-pulmonary arterial shunt (n=2), tricuspid valve repair (n=1), and Fontan operation (n=1). Bi-directional cavopulmonary shunt (BCPS) was required in 5 patients. Among the 2 neonates, one patient underwent successful biventricular repair, and the other patient underwent systemic-to-pulmonary arterial shunt. Follow-up was possible in 21 patients (75%), and the average follow-up was 37.6 months (3 months~11.3 years). RESULT: There were 1(3.4%) early and 1 late deaths. Reoperation was required in 4 patients. Two patients underwent tricuspid valve re-replacement, and the other 2 tricuspid valve repair. At recent follow-up, only 2 patients showed tricuspid insufficiency equal to or greater than grade 3, and most patients showed clinical improvement. Excluding the patients who underwent tricuspid valve replacement, the actuarial rate of freedom from reoperation at 1 and 5 years were 94.7% and 79.0%, respectively. CONCLUSION: Tricuspid valve repair was possible in most patients with good mid-term outcome. Most patients showed clinical and hemodynamic improvement. Indications for the BCPS should be clarified.

Tricuspid Replacement through Right Thoracotomy in Reoperation: A case report / 대한흉부외과학회지

In an extremely enlarged right heart, the repeated midline sternotomy was considered to involve the risk of massive hemorrhage. A right thoracotomy provides a convenient and safe way to approach the tricuspid valve in patient who have had previous heart surgery through a midline sternotomy.