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Tricuspid Valve Replacement With a Sewing Ring Extender to Address Conduction Abnormalities
Elizabeth L Norton1, Kanika Kalra1, Robert A Guyton1
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Abstract:
Tricuspid valve surgery is associated with a high risk of new permanent pacemaker implantation. Tension on annular tissue by placement of a circular valve in a very noncircular annulus may cause conduction abnormalities. To address this, a triangular piece of pericardium was sewn to the prosthesis sewing ring, extending the sewing ring into the corner of the annulus between the septal and anterior leaflets, visibly relieving tension in the region of the atrioventricular node in five patients. A sewing ring extension of the prosthesis should be explored during tricuspid valve replacement to potentially reduce the risk of conduction system impairment.
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