Redo Tricuspid Valve Repair with Leaflet Augmentation Using the Left Atrial Wall

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Regenerative Medicine

Background:

• Recurrent severe tricuspid regurgitation (TR) poses a significant clinical challenge, often necessitating complex surgical interventions.
• Previous cardiac surgeries and comorbidities like chronic heart failure can complicate TR management.
• Autologous pericardium, a common graft material for valve repair, may be unsuitable due to calcification or prior use.

Observation:

• A 79-year-old female patient with a history of multiple cardiac surgeries presented with chronic heart failure and recurrent severe TR.
• Standard tricuspid valve repair techniques were insufficient; leaflet augmentation was required.
• The patient's left atrium was significantly enlarged (giant left atrium) and its wall was thin and pliable, making it suitable for resection and use as a graft.

Findings:

• A successful tricuspid valve repair was achieved using a patch fashioned from a resected portion of the left atrial wall for leaflet augmentation.
• This represents the first reported use of a left atrial wall graft for tricuspid leaflet augmentation.
• The procedure addressed both leaflet tethering and regurgitation, alongside tricuspid annuloplasty.

Implications:

• This technique offers a valuable alternative for tricuspid valve repair in cases where autologous pericardium is not available or suitable.
• Utilizing resected atrial wall tissue provides a readily available autograft for complex valve reconstructions.
• This method expands the surgical armamentarium for managing challenging tricuspid regurgitation cases, potentially improving patient outcomes.