Mid-term Results of Contemporary Approach for Tricuspid Valve Reconstruction due to Infective Endocarditis

Roman I. Amiragov, Ravil M. Muratov, Svetlana I. Babenko, Dmitriy V. Britikov, Leo A. Bockeria

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Background: Surgical repair of tricuspid regurgitation after medical management of infective endocarditis can present a challenging scenario. TV replacement leads to good intermediate results, but has unsatisfactory late results.

Methods: Total of 202 TV procedures were established between 2001 and 2017. TV replacement was initiated in 92 patients, TV reconstruction in 110 patients (mean age, 32.5 ± 15.5, 97 women, 94 men). Standard techniques-partial resection, patch repair, chordae translocation, were used for 79 patients. We have started new approach to restoration of TV for candidates to replacement since 2008. Neoleaflets of auto (xeno) pericardium and loops of neochordae were used for valve restoration accompanied with annuloplasty for 29 patients. Isolated TVR was performed for 27 patients (92.8%), for 1 patient (3.6%) with AVR, and other 1 (3.6%) VSD, ASD closure, also in other one patient we completely reconstructed all leaflets. Preoperatively moderate to severe TV regurgitation observed in all patients. We have used autopericardium for replacement of leaflet(s) in 23 cases and xenopericardium in 6 cases. PTFE bands(5cm) were used for annuloplasty.

Results: Hospital mortality was 3.5% (n=1). The mortality up to 10 years was 20.7% (n=6). All patients were in NYHA class I. All patients presented with sinus rhythm without AV blockage. 15 (53.5%) patients were observed in midterm period. Completeness of follow-up was 92.8%. Mean follow-up was 49mths. We had 4 redo’s at 6, 7, 8, 11 mths due to recurrent drug abusers. Freedom from recurrent IE was 75.8%. 2 patients have moderate regurge, 7–trivial, other don’t have any residual leak.

Conclusions: Our technique of cusp and chords formation demonstrates improved and stable intermediate and midterm outcomes.This approach should be alternative for valve replacement.