Tricuspid Annuloplasty with Combined Papillary Muscle Relocation by Spiral Suspension Technique

Ichiro Matsumaru, Kiyoyuki Eishi, Kikuko Obase, Takashi Miura, Kazuyoshi Tanigawa, Tomohiro Odate, Yuichi Tasaki, Yutaro Kawaguchi

Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–B

Abstract

Objectives:

With the increase in valvular disease, cases requiring intervention in tricuspid regurgitation (TR) are increasing. In many cases, regurgitation control is possible with only tricuspid annuloplasty (TAP), but in patients with severely tethered leaflets, repair with ring annuloplasty alone results in residual or recurrent tricuspid regurgitation (TR). It has been reported that tricuspid valve replacement is associated with worse outcome than TAP. However, in order to overcome this problem, our team has developed “spiral suspension” as a novel technique of papillary muscle (PM) relocation.

Methods:

From February 2007 to July 2017, among the 198 patients who underwent TAP at our institution, the spiral suspension technique was applied to 10 patients (5.0%) with severe TR with tethering. The spiral suspension procedures were as follows; prior to the annuloplasty, pledgetted polytetrafluoroethylene suture was placed at the base of anterior PM. Then, in a clockwise fashion, the base of accessory posterior PM and that of posterior PM were continuously sutured by each arm. The arms were passed interventricular septum and then exteriorized onto the septal annulus. After ring annuloplasty, the sutures were passed through the ring. The adjustment of the suture length was carefully performed under saline test, with observing the leaflet movement, and then the sutures were tied.

Results:

A patient with severe congestive liver cirrhosis before surgery was lost by right heart failure on day 34 postoperatively, but in 9 patients who survived and discharged, post-operative Tr were less than trivial.

Conclusions:

 With an understanding of the tricuspid subvalvular anatomy, spiral suspension is a simple and easy procedure, which enables to reduce leaflet tethering and secure leaflets coaptation. This may be a promising procedure for eliminating severe functional TR. Further investigation is needed.