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Eur J Cardiothorac Surg 2004;25:760-765
© 2004 Elsevier Science NL

A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions

Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy

Received 28 September 2003; received in revised form 24 January 2004; accepted 28 January 2004.

^* Corresponding author. Tel.: +39-2-2643-7102-09; fax: +39-2-2643-7125
e-mail: michele.debonis{at}hsr.it

Objectives: Correction of tricuspid regurgitation due to complex lesions (not treatable with annuloplasty only) is associated with suboptimal results. To improve the efficacy of valve repair in this context, we developed a new surgical approach, which consists of stitching together the central part of the free edges of the leaflets producing a ‘clover’ shaped valve. Our preliminary experience with this novel technique is reported. Methods: Between 2001 and 2003, 14 patients (mean age 57±17 years), with severe tricuspid regurgitation due to complex lesions, underwent valve repair with this novel approach in combination with annuloplasty. The aetiology of the disease was post-traumatic in five cases, degenerative in eight and secondary to dilated cardiomyopathy in one. Anterior leaflet prolapse/flail was present in most patients associated with posterior and/or septal leaflet prolapse or tethering. Annular and right ventricular dilatation was present in all cases. Mitral valve repair/replacement was concomitantly performed in nine patients. Results: Hospital mortality was 7.1% (1/14). At follow-up extending to 22 months (mean 12±6.3), all survivors were asymptomatic. At the last echocardiogram tricuspid regurgitation was absent or mild in 13 patients and moderate in one. Mean tricuspid valve area and gradient were 4.2±0.4 cm² and 2.7±1.4 mmHg, respectively. Conclusions: Despite the short follow-up, this novel technique appears to be an easy, rapid and effective approach to correct severe tricuspid regurgitation due to complex lesions. Such a repair restored tricuspid valve competence, even in the presence of huge RV dilatation and pulmonary hypertension.

Key Words: Tricuspid regurgitation • Tricuspid prolapse • Valve repair

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