Impact of Isolated Tricuspid Valve Repair on Right Ventricular Remodelling in an Adult Congenital Heart Disease Population

Abstract

BackgroundSurgical repair of isolated congenital tricuspid valve (TV) disease is rare with no well-defined indication and outcomes. Moreover, the role of right ventricle (RV) in this context has not yet been investigated.ObjectivesWe sought to assess the impact of congenital TV repair on cardiac remodelling and clinical–functional status and the importance of the RV function in an adult congenital heart disease (ACHD) population.Methods and resultsFrom January 2005 to December 2015, 304 patients underwent TV surgery in our centre. Of these, 27 (ACHD) patients had isolated TV repair. Patients were evaluated with preoperative and postoperative transthoracic echocardiogram. Survival rate has been investigated with a mean clinical follow-up (FU) of 3.7 ± 2.3 years, whereas the mean echocardiographic FU was 2.9 ± 1.8 years. The clinical and functional status of patients showed a statistically significant improvement after the surgical repair in terms of New York Heart Association class (66.7 vs 7.4%; p < 0.01), clinical signs of heart failure (29.6 vs 7.4%; p < 0.01), and left ventricular function (14.8 vs 7.4%; p < 0.01). The RV and right atrium diameter were significantly reduced after surgery (5.15 ± 1.21 vs 4.32 ± 1.16; p < 0.01) and (44.7 ± 16.7 vs 26.7 ± 9.2; p < 0.01), respectively. The degree of postoperative pulmonary hypertension was also significantly reduced (40.7 vs 7.4%; p < 0.01). The survival rate was 96.3% at 1 year and 93.7% at 5 years. One patient (3.7%) had early failure of the tricuspid repair requiring a reoperation.ConclusionIsolated TV repair for adult congenital disease significantly improved patients’ clinical and functional status and allowed right ventricular remodelling and functional improvement.

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

“…A catastrophic bleeding before the establishment of CPB would be encountered during resternotomy for TV surgery due to the excessive retrosternal and intrapericardial adhesion and extremely enlarged right ventricle protruding to the sternum. [22][23][24] However, the dense retrosternal adhesion for reoperative TV surgery was no longer a problem when it came to totally thoracoscopic TV repair due to the avoidance of aortic cannulation, extensive mobilization of the intrapericardial adhesion, as well as vena cava snaring. Instead, we could make good use of the extensive pericardial adhesion if the right atriotomy and pericardiotomy were performed simultaneously with blade 11, which thus greatly decreased the iatrogenic operative injuries and postoperative bleeding.…”