Flexible band made of autologous pericardium for functional tricuspid regurgitation repair

Abstract

Introduction: Secondary (Functional) tricuspid regurgitation (TR) is a common problem in cardiac surgery that occurs secondary to left-sided valvular heart disease, more evident with mitral valve pathology, especially mitral stenosis. Right ventricular overload caused by pulmonary hypertension is the main leading factor causing right ventricular enlargement and tricuspid annular dilatation. Many techniques were developed for repair of tricuspid incompetence. Some techniques failed to show good results and even the regurgitation may recur with progression of disease. We studied the early results of tricuspid annuloplasty procedure using flexible band made of autologous pericardium.Methods: The study was conducted from September 2016 to July 2018. Thirty patients treated with tricuspid annuloplasty using flexible band made of autologous pericardium for functional TR. Concomitant procedures included mitral valve replacement in 24 patients and mitral-aortic valve replacement in 6 patients. Follow-ups both clinically to assess the functional status (NYHA class) and by echocardiography were used to judge on success of repair. During the study, another nine patients were treated with Devega repair due to surgeon preference. The results with this method were compared with a group collected from the records.Results: Thirty patients were operated using a flexible band of pericardium and followed up for at least 1 year. There was no mortality, neither in hospital nor during follow-up period. The severity of TR and the functional status improved with time. Twenty-eight patients (93.3%) were in NYHA class I at 1-year postoperative follow-up. Freedom from recurrent TR was 96.7% at 1 year. In comparison to the traditionally used Devega repair, there were no statistical differences neither in postoperative TR nor in functional status.Discussion: Tricuspid repair using flexible band of autologous pericardium is an option for functional TR. Further studies with a larger number of samples and a longer term of follow-up are necessary to confirm our findings.