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Layer Microdissection of Tricuspid Valve Leaflets for Biaxial Mechanical Characterization and Microstructural Quantification
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Tricuspid Valve Detachment in Ventricular Septal Defect Closure Does Not Impact Valve Function
Charles D Fraser1, Xun Zhou1, Sandeep Palepu1
1Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
The Annals of Thoracic Surgery
|April 7, 2018
Summary
Tricuspid valve detachment (TVD) during ventricular septal defect (VSD) closure does not negatively impact long-term valve durability or increase patient morbidity. This technique is a safe adjunct for improving surgical exposure when needed.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Tricuspid valve detachment (TVD) improves surgical exposure for transatrial ventricular septal defect (VSD) closure.
- The long-term effects of TVD on tricuspid valve durability remain under-investigated.
Purpose of the Study:
- To evaluate the impact of TVD on long-term tricuspid valve durability after VSD closure.
- To assess secondary outcomes including atrioventricular dissociation, residual VSD, and reinterventions.
Main Methods:
- Retrospective review of pediatric patients undergoing VSD closure between 1997 and 2013.
- Patients were grouped based on the use of TVD and propensity score matching was performed.
- Primary outcome was residual tricuspid valve dysfunction (TR) at long-term follow-up.
Main Results:
- A total of 247 patients underwent VSD closure; 83 with TVD and 164 without.
- After propensity score matching, mild tricuspid regurgitation (TR) prevalence was similar between groups (33.7% with TVD vs. 34.9% without TVD; p=0.87).
- Moderate TR was rare in both groups, and transient atrioventricular block occurred in one patient per group.
Conclusions:
- TVD does not compromise long-term valve durability after VSD closure.
- TVD is a safe and effective adjunct, not associated with increased morbidity.
- The technique is recommended when surgical exposure is challenging.
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