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1 I have nothing to disclose.
2 New approaches in tricuspid valve repair Christian Schreiber
3 ..more than a simple displacement.., the valvar orifice is formed within the ventricular cavity..
4 Ebstein Historical evolution OP technique without plication Diagnosis intra vitam TV-plasty Hunter, Lillehei TV-plasty Hardy TV-plasty Sebening (DHM) W. Ebstein Palliation TV-replacement Barnard TV-plasty Danielson TV-plasty Carpentier Cone repair da Silva
5 Operative approaches German Heart Centre ( /2011) Op procedure % n Plasty Replacement Palliation Overall 152
6 Issues with repair techniques Pat n 30-day mortality % Plasty % Re-OP % OP technique Watson (Int. study) Danielson et al transverse plication Renfu et al various plications Chauvaud et al longitudinal plication Multi-Center study (ECHSA) various DHM no plication
7 Operative approaches German Heart Centre ( /2011) 2% 7% 9% 5% 13% 54% 10% Monocusp ( ) Hardy ( ) Bicuspid ( ) DeVega ( ) TK Ring Other techniques "Cone repair" (since 2010)
8 Other repair techniques Monocusp plasty with transverse plication (GK Danielson et al., Mayo Clinic Proc, 1979) a b c d e
9 Other repair techniques Dearani/Danielson technique - the base of the papillary muscle(s) is moved towards the ventricular septum. With or without plication. (Surgery of the Chest, Elsevier Sounders, Dearani 2005) a b c c d e f g
10 Other repair techniques Sebening single-stitch (monocusp plasty) Ann Thorac Surg 2007;84:587-93
11 Monocusp ( single stich ) valvuloplasty (Sebening)
12 Ebstein Historical evolution OP technique without plication Diagnosis intra vitam TV-plasty Hunter, Lillehei TV-plasty Hardy TV-plasty Sebening (DHM) W. Ebstein Palliation TV-replacement Barnard TV-plasty Danielson TV-plasty Carpentier Cone repair da Silva
13 Cone repair Courtesy of JP da Silva
14 We have developed a new surgical technique, which main feature is the cone reconstruction of the tricuspid valve. The idea was to cover 360º of the right AV junction with leaflet tissue, allowing leaflet to leaflet coaptation. Arq Bras Cardiol 2004;82:
15 Da Silva experience (November 1993 to January 2010) 90 consecutive patients mean age: 17.6 ± 13.7 years (median 13.5 y) Associated anomalies: ASD or patent oval foramen 80 (88.5%) Accessory conduction pathway (WPW) 14 (17.9%) VSD 1 (1.3%) Pulmonary stenosis 3 (3.8%) Pulmonary atresia 3 (3.8%) Partial anomalous pulm. ven. return 1 (1.3%) Courtesy of JP da Silva
16 Da Silva experience (November 1993 to January 2010) Mean follow-up 64.4 ±45.1 months (98.8% of patients) EVENTS NUMBER CAUSES Hospital deaths 3 (3.3%) Low cardiac output Late deaths 4 (4.4%) Endocardites Heart failure +arrhythmia Sudden death (arrhythmia?) Pool accident TV re-repair 4 (4.4%) Increased regurgitation A-V block 1 (1.1%) β blocker and amiodarone use, one year after operation TV replacement 0 Courtesy of JP da Silva
17
18 Mobilization of parts of anterior and posterior leaflet
19 Mobilization of anteroseptal commisure and septal leaflet
20 Cone creation : joining all (mobilized) leaflet parts
21 Attaching the Cone to the annulus
22 Cone repair (da Silva)
23
24
25 Pre-/postoperative work-up
26 Pre-/postoperative work-up
27 Conclusions Only if any tricuspid valve repair does not lead to a significant reduction of tricuspid insufficiency we advocate primary valve replacement. Creation of a monocusp valve is a good option in selected patients. The Cone repair yields promising results, allowing leaflet to leaflet coaptation and propably restoring RV function.
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