Tricuspid valve repair: a rational alternative

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Surgical Innovation

Background:

• Traditional tricuspid valve repair methods like prosthetic ring annuloplasty are limited to cases of annular dilatation.
• These methods are less effective when organic tricuspid valve disease is present.
• A new surgical technique aims to address both functional and organic tricuspid valve incompetence.

Purpose of the Study:

• To present and evaluate a novel surgical technique for tricuspid valve repair.
• To assess the efficacy of this method in correcting both functional and organic tricuspid valve disease.
• To determine the long-term stability and outcomes of the described tricuspid valve repair.

Main Methods:

• The Manipal method involves three key steps: anteroseptal commissurotomy with asymmetric suture annuloplasty, De Vega-type plicating suture exclusion of the posterior leaflet, and size-guided annuloplasty.
• A valve sizer (3M Starr-Edward) is used to ensure the tricuspid orifice is not excessively narrowed.
• This technique was applied to 52 tricuspid valves between July 1986 and January 1997, often combined with other cardiac valve surgeries.

Main Results:

• The Manipal method was used in 52 tricuspid valve repairs, with 61% presenting with tricuspid stenosis.
• One hospital death was valve-related; however, long-term follow-up (up to 10 years) showed no need for reoperation in 78% of patients.
• No patient experienced more than mild tricuspid regurgitation clinically, even years after the repair.

Conclusions:

• The Manipal method offers a simple and effective alternative for tricuspid valve repair.
• It successfully corrects both pure tricuspid regurgitation and organic tricuspid valve disease.
• The technique demonstrates excellent long-term stability and patient outcomes.