The Double-Orifice Valve Technique to Treat Tricuspid Valve Incompetence

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Surgical Techniques

Background:

• Tricuspid valve (TV) incompetence can be functional or organic, often involving annular dilatation and leaflet/chordal abnormalities.
• Assessing long-term outcomes of TV repair techniques is crucial for managing tricuspid regurgitation.

Purpose of the Study:

• To evaluate the long-term efficacy of a straightforward double-orifice tricuspid valve repair technique.
• To assess the outcomes in patients with moderate to severe functional or primary/organic tricuspid valve incompetence.

Main Methods:

• A double-orifice valve technique was performed on 91 patients with severe tricuspid regurgitation.
• The technique involves creating two orifices to ensure leaflet coaptation, with specific orifice sizes defined for adults and children based on body surface area.
• Repairs were conducted via median sternotomy or right anterior thoracotomy under cardiopulmonary bypass.

Main Results:

• A mean follow-up of 8.7 years showed no reoperations for tricuspid valve insufficiency or stenosis.
• The cumulative 12-year survival rate was 86.9%.
• Three patients required reoperation for other cardiac conditions, including aortic valve replacement and assist device implantation preceding heart transplant.

Conclusions:

• The double-orifice technique is a straightforward and effective method for abolishing tricuspid valve incompetence.
• The technique yields highly satisfactory results, especially in patients with severe annular dilatation or leaflet/chordal tethering.
• No residual regurgitation or need for reoperation was observed during the follow-up period, provided the conduction system's location was considered.