Tricuspid Annuloplasty Using a Handmade Gore-Tex Band: A Retrospective Study, Case Series, and Literature Review

TL;DR

This paper presents a new surgical technique using a handmade Gore-Tex band to repair the tricuspid valve, showing effective short- and long-term results.

Contribution

The novel contribution is a simple, handmade Gore-Tex band annuloplasty technique for tricuspid valve repair not previously described in the literature.

Findings

The Gore-Tex band technique showed effective tricuspid valve repair with 77.7% of patients having mild regurgitation long-term.

The method is described as simple, reproducible, and cost-effective based on outcomes in 10 patients.

Preoperative severe tricuspid regurgitation improved significantly post-surgery and during follow-up.

Abstract

Background

Tricuspid valve regurgitation is frequently overlooked by cardiologists and cardiac surgeons alike; consequently, the tricuspid valve is often referred to as “the forgotten” valve. It is the most common complication of left heart valve disease. Ring annuloplasty and suture (De Vega) annuloplasty represent two common surgical treatment techniques. We developed a technique to stabilize the tricuspid annulus using a simple handmade Gore-Tex vascular prosthesis. Our literature review did not reveal any publications describing an identical approach.

Objectives

In this article, we report the results of our technique for repairing the tricuspid valve, particularly emphasizing both the short- and long-term echocardiographic outcomes, along with a review of current tricuspid valve repair surgical techniques.

Methods

This retrospective study investigated the outcomes of 10 patients who underwent tricuspid valve repair via the tailoring of a simple Gore-Tex vascular graft and implanting it in the tricuspid annulus. Transthoracic echocardiography was used for the preoperative and postoperative evaluation of tricuspid regurgitation (TR). The minimum postoperative follow-up time was three months, compared with a maximum follow-up period of five years. Echocardiographic follow-up was employed to assess the patency of the tricuspid valve repairs. Data are presented as percentages, means, and standard deviations. Statistical analyses were conducted using SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). The primary outcome measures were in-hospital and long-term tricuspid valve competence. We reviewed the literature on tricuspid valve repair to provide a brief overview of this topic.

Results

The study group comprised 10 patients (8 women and 2 men) with a mean age of 62.3 ± 14.46 years. At hospital admission, all patients were categorized as either NYHA (New York Heart Association) functional class III (80%) or IV (20%). Preoperative TR was severe in 70% of patients and moderate in 30%. The mean pulmonary artery pressure was 57.6 ± 14.98 mmHg. In most patients, the primary indication for surgery was mitral valve pathology in 70% of patients, followed by interatrial septal defect in 30% of patients. Immediately after surgery, nine patients exhibited 1+ TR and one patient had 2+ TR. After long-term follow-up, 77.7% of patients had 1+ TR and 22.3% had 2+ TR.

Conclusions

Tricuspid valve repair using handmade Gore-Tex band annuloplasty can be an effective method, yielding excellent early and long-term outcomes regarding repair patency, as assessed by echocardiography. This technique is simple, reproducible, and cost-effective.

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