OUTCOMES OF COMPLEX RECONSTRUCTION OF THE TRICUSPID VALVE: FROM THE RING TO THE LEAFLETS AND SUBVALVULAR STRUCTURES

Highlights

This paper presents the long-term results of complex tricuspid valve reconstructions in severe secondary tricuspid insufficiency, such as the extension of the anterior tricuspid valve flap, the “clover” technique, as well as the immediate results of the convergence of the papillary muscles of the right ventricle. This generalized material has no analogues in the Russian-language literature and familiarization with it will expand the indications, durability and safety of tricuspid valve reconstructions.

Abstract

Aim. Tricuspid annuloplasty of the tricuspid valve is the most common and, in the vast majority of cases, the only intervention on the tricuspid valve performed for tricuspid regurgitation. However, there are a number of problems that cause dissatisfaction with a single-component treatment of the tricuspid valve, such as: the risk of recurrence of TR 2, varying from 10 to 32% depending on the annuloplasty method; high mortality during reoperation on the tricuspid valve due to the return of TR.

Methods. From 2010 to 2017, anterior leaflet augmentation of the tricuspid valve was performed in 18 patients with severe TR. According to the etiology of TR, the patients were divided into 2 groups: Group 1 – patients with organic disease of the tricuspid valve (rheumatism – 10 patients, congenital heart disease – 2 patients); Group 2 – with functional TR (6 patients). For the period from 2004 to 2019. The “clover” technique was used in TR correction in 28 patients. Myxomatosis was the predominant etiology of TR in 16 cases, functional disease of the tricuspid valve – 7 patients, rheumatism – 3 patients, infective endocarditis – 2 patients.

Results. Freedom from recurrence of TR ≥ grade 2 in the long-term period in the “clover” group was 75% (with myxomatosis – 85,7%), in the “augmentation” group – 100% with functional defect and 60% with organic valve disease. Freedom from recurrence of TR ≥ grade 3 in the “edge to edge” group was 87.5% (with myxomatosis – 100%), in the “augmentation” group – 100% with functional disease and 81.8% with organic valve disease. In the edge-to-edge group, a correlation was found between the degree of TR in the late period and the implementation of additional maneuvers on the tricuspid valve (excision of secondary chords and anterior leaflet augmentation r = 0.5, p = 0.037 and r = 0.5, p = 0.048, respectively).

Conclusion. The results of anterior leaflet augmentation of the tricuspid valve in case of functional TR, the edge-to-edge suture in case of valve myxomatosis are satisfactory and allow to expand the indications for reconstructive surgery, the techniques are reproducible, safe and durability.

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