Ahmed Ouda1, Klaus Matschke1, Tamer Ghazy1, Uwe Speiser2, Konstantin Alexiou1, Sems-Malte Tugtekin1, Steffen Schoen2, Utz Kappert1
Departments of 1Cardiac Surgery and 2Cardiology, Dresden Heart Center, Dresden, Germany
Background and aim of the study: The study aim was to assess the impact of reducing the right ventricular (RV) cavity in order to optimize the outcome of tricuspid valve (TV) repair in cases of functional tricuspid regurgitation (FTR) with dilated right ventricle.
Methods: Between May 2007 and February 2010, a total of 17 patients (six males, 11 females; mean age 69.5 ± 10.1 years; mean logistic EuroSCORE 24 ± 13%) with severe FTR and severe RV dilation were included. Echocardiography and magnetic resonance imaging (MRI) were performed for geometric assessment of the right ventricle. Intraoperatively, the lateral RV free wall was plicated to reduce the RV cavum to approximate the papillary muscles and decrease tethering of the TV; a conventional ring annuloplasty was then performed. Follow up included echocardiography and MRI at one month and one year postoperatively.
Results: The mean operative time was 157 ± 30 min, and
the cross-clamp time 63 ± 13 min. Postoperatively, the mean bleeding volume was 486 ± 455 ml, the rethoracotomy rate 5.9%, intensive therapy unit (ITU) stay 6.0 ± 4.4 days, and hospital stay 19.0 ± 8.8 days. In-hospital mortality was 17.6%. The mean follow up was 14.4 ± 2.4 months. The one-year follow up revealed a survival of 82.3%, a slight decrease in RV ejection fraction (from 33.5 ± 4.2% to 31.7 ± 5.7%; p = 0.13), a significant reduction in the RV end-diastolic volume index (from 160 ± 15.6 to 128 ± 10 ml/m2; p = 0.0001), a reduction in TV tenting area(from 3.3 ± 0.9 to 0.9 ± 0.3 cm2; p = 0.0001), and a significant reduction in the ratio of TR jet to right atrial surface area (from 54.8 ± 8.2% to 14.1 ± 3.5%; p = 0.0001).
Conclusion: In cases of FTR, RV dilation may be considered as a correctable factor at subvalvular level to optimize the outcome of TV repair.
The Journal of Heart Valve Disease 2013;22:754-761
|Right Ventricular Reduction for Repair of Functional Tricuspid Valve Regurgitation: One-Year Follow Up|
Click the above hyperlink to view the article, right click (Ctrl click on a Mac) to open in a new browser window or tab.
Please click the button below to purchase this article. Single article purchases are provided at $50.00 per article. Upon clicking the button below, single article user account subscription details are requested and, upon successful payment, a single article user account is created. Single articles are availble in your account for seven days after purchase.