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TRICUSPID VALVE REPAIRWHEN AND HOW?. Functional Tricuspid Insufficiency... Organic tricuspid regurgitation„ Leaflet : thickening, shrinkage and retraction... „ Combined tricuspid correct

TRICUSPID VALVE REPAIR

WHEN AND HOW ?

NGUYEN VAN PHAN MD PhD VAN HUNG DUNG MD MS

ALAIN CARPENTIER FOUNDATION

„ Concomitant tricuspid regurgitation was

presented in 50% of mitral valve disease and 30% of multi valve disease

„ Questions :

● Pathological characteristic ?

● Indication for surgery ?

● Surgical techniques ?

Anatomy

Anapathology

Pathology

„ Functional TR

„ Organic TR

Functional Tricuspid Insufficiency

Organic tricuspid regurgitation

„ Leaflet : thickening, shrinkage and retraction

„ Annulus : dilatation ( anterior and posterior)

„ Commissure : fusion

„ Chordae :thickening, fusion and retraction

Indication for surgery

„ TR with severe enlargement of right side chambers

„ TR with pulmonary artery hypertension

Surgical techniques

„ From 01/1992 to 01/2008; 5425 patients with

mitral valve and polyvalvular disease were

operated at The Heart Institute – Viet Nam

„ Combined tricuspid correction was performed in 35.9% of them

Combined tricuspid correction with other valve

surgery

N= 1949 patients ( 35.9%)

posterior annuloplasty

Mitral valve repair

Mitral valve replacement

Polyvalvular disease

2795 1394 1236

Results

Depend on :

1 Surgical techniques for tricuspid valve

2 Surgical techniques for mitral valve

3 Hypertention of pulmonary artery

4 Functional or organic TR

5 Dilatation of the right ventricle

6 AF or SR

Results

technique

„ Mc Cathy : 790 case (1990-1999)

Results

„ Tirone David : 702 cases (1978 – 2003)

Results

„ Tirone David : 702 cases (1978 – 2003)

Results ( The Heart Institute)

„ N.V.Phan – V.H.Dung : 1949 cases (1992 – 2008)

35

40 25

No Ring Annuloplasty

Recurrent TR after surgery

„ Progressive rheumatic valve disease

„ Failed mitral valve repair

„ Mitral prosthetic valve dysfunction

„ Persistence of pulmonary artery hypertension

„ Myocardial ischemia of right ventricle during

previous operation

„ Tricuspid annulus dilatation : not recommended

by surgeon during previous operation

„ Reoperation for severe TR = 3-4 %

Assessment of TR after surgery

„ Tirone David : 702 cases (1978 -2003)

„ Meantime of follow up = 13.4 y.o

34.1 5.1 60.8

5.9 4.6 0.6

A.Carpentier(1969-1974): 917 patients

Meantime of follow up = 3.5 y.o

„ Question 1 : will moderate functional TR disappear after MV surgery ?

„ Among 4189 patients with mitral valve surgery

in The Heart Institute –Viet Nam Combined TR correction was carried out in 1433 patients

(82%)

„ TR incorrection = 314 patients (18%)

Persistence of tricuspid

regurgitation

„ Linerized rate = 1.74 %/pts/year

Ho Huynh QT , PhD thesis 2010

Persistence TR according to

mitral procedure

Ho Huynh QT , PhD thesis 2010

„ Question 2 : Do they need reoperation ?

„ Reoperation = 63 (20%) (combined with repeat

MV surgery)

THANK FOR YOUR ATTENTION