Post-operative results of tricuspid annuloplasty with teflon felt

Authors

  • P. Sai Surabhi Department of Cardio-Thoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
  • Avinash Tadiboina Department of Cardio-Thoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
  • R. V. Kumar Department of Cardio-Thoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
  • Tella Ramakrishna Dev Department of Cardio-Thoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20210889

Keywords:

Tricuspid regurgitation, Tricuspid valve repair, Tricuspid annuloplasty, Teflon felt

Abstract

Background: Surgical treatment of functional tricuspid valve regurgitation (TR) with left-sided valvular disease still remains a challenge for the cardiac surgeon. We present our observations and results on the usage of Teflon felt as an economic and easily available option for the management for tricuspid disease with an emphasis on the ease of procedure.

Methods: In this study 50 (27 male and 23 female) adult skulls were investigated to determine the type of asterion, its distance from important bony landmarks and also the nearby venous sinuses were measured.

Results: Epidemiological data like age, gender, symptomatic status using NYHA class, intraoperative details including the procedure performed, cardiopulmonary bypass and cross clamp time were noted. Patients’ preoperative echocardiograms, postoperative echocardiograms done at 1 month, 3 month and 6 month and yearly follow ups were made note of. Most of the patients in our study group are in 4th decade of life with slight female preponderance. Tricuspid regurgitation secondary to rheumatic valvular disease involving left sided valves is the most common etiology. The average size of the teflon felt was sized to the standard SJM sizer and sized to 28.56±3.7 mm. The average CPB time is 138 min 19 sec and average cross clamp time 89 min 14 sec. Five patients had postoperative RV dysfunction out of which three patients recovered with medical management. Overall in-hospital mortality in our study group is 6 (8%). 3 of them died due to low cardiac output, two patients due to sepsis and MODS and one due to bleeding.

Conclusions: Annuloplasty with customised hard teflon felt is a safe, easily reproducible, economic alternative with good results and less mortality and morbidity.

References

World Health organization website world heart day 2017-Global burden of cardiovascular disease. Avaialable at: http://www.who.int/cardiovascular_diseases/en/. Accessed on: 12 December 2020.

Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India: Current Epidemiology and Future Directions. Circulation. 2016;133(16):1605-20.

Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience. Indian Heart J. 2014;66(3):320-6.

Anyanwu AC, Chikwe J, Adams DH. Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery. Curr Cardiol Rep. 2008;10(2):110-7.

McCarthy PM, Bhudia SK, Rajeswaran J, Hoercher KJ, Lytle BW, Cosgrove DM, Blackstone EH. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg. 2004;127(3):674-85.

Carpentier A. Cardiac valve surgery--the "French correction". J Thorac Cardiovasc Surg. 1983;86(3):323-37.

Bonis MD, Taramasso M, Lapenna E, Alfieri O. Management of Tricuspid regurgitation. F1000 Prime Rep. 2014;6:58.

Prabhakar G, Kumar N, Gometza B. Surgery for organic rheumatic disease of the organic valve. J Heart Valve Dis. 1993;2:561-6.

Duran CM, Pomar JL, Colman T, Figueroa A, Revuelta JM, Ubago JL. Is tricuspid valve repair necessary? J Thorac Cardiovasc Surg. 1980;80(6):849-60.

Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79(1):127-32.

Buzzatti N, Iaci G, Taramasso M, Nisi T, Lapenna E, De Bonis M, Maisano F, Alfieri O. Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery. Eur J Cardiothorac Surg. 2014;46(4):713-9.

Lopes LR, Loureiro MJ, Miranda R. The usefulness of contrast during exercise echocardiography for the assessment of systolic pulmonary pressure. Cardiovascular Ultrasound. 2008;6:51.

Shah PM, Raney AA. Tricuspid valve disease. Curr Prob Cardiol. 2002;33:47-84.

Raja SG, Dreyfus GD. Basis for intervention on functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg. 2010;22:79-83.

Braunwald NS, Ross J, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967;35(4):163-9.

Tanaka M, Takeuchi E, Watanabe T. Tricuspid Annuloplasty-Modified Technique. Nihon KyoboGeka Gakkai Zasshi. 1990;38(10)2034-8.

Mittal CM, Talwar S, Kumar AS. Randomized trial comparing the use of carpentier’s ring with posterior segment annuloplasty using a c shaped ring of Teflon felt for mitral valve repair in rheumatic population. Indian J Cardiovasc Surg. 2009;25:114-7.

Antunes MJ, Med M, Girdwood RW. Tricuspid Annuloplasty: A Modified Technique. Ann Thorac Surg. 1983.

Drake RL, Vogl AW, Mitchell AWH. Gray’s anatomy for students. 3rd edition. 2014.

Bonow RO, Mann DL, Zipes DP. Brawunwald’s Heart Disease: A textbook of Cardiovascular Medicine. 9th edition. 2012.

Sadler TW. Langman’s Medical Embryology. 13th edition. Lippincott Williams and Wilkins. 2011.

Kouchoukos NT, Blackstone EH, Hanley FL. Kirklin/Barratt-Boyes Cardiac Surgery. 4th edition. Saunders. 2013.

Carpentier A, Adams DH, Filsoufi S. Carpentier’s Reconstructive Valve Surgery. 1st edition. Saunders. 2010.

Alpert JS, Dalen JE, Rahimtoola SH. Valvular Heart Disease. 3rd edition. Lippincott Williams and Wilkins. 2000.

Cohn LH, Adams DH. Cardiac Surgery in the Adult. 5th edition. McGraw-Hill Education. 2018.

Khorsandi M, Banerjee A, Singh H, Srivastava AR. Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation? Interact Cardiovasc Thorac Surg. 2012;15(1):129-35.

Antunes MJ, Girdwood RW. Tricuspid annuloplasty: a modified technique. Ann Thorac Surg. 1983;35(6):676-8.

Ren WJ, Zang BG, Liu JS, Qian YJ. Outcomes of tricuspid annuloplasty with and without prosthetic rings:a retrospective follow up study. J Cardiothorac Surg. 2015;10:8.

Meduri CU, Rajagopal V, Vannan MA, Feldt K, Latib A. Transcatheter Tricuspid Valve Therapies: A look at the current state of this final valve frontier. Cardiac Interv Today. Mitral Tricuspid Trans-Catheter Ther. 2017.

Taggarse AK, Amaresh RM, Dharmarakshak A, Kumar RV, Mishra RC. The TRACET study: Tricuspid valve repair by annuloplasty-comparitive evolution of techniques. Indian J Thorac Cardio-Vasc Surg. 2010;26:68.

Kuwata S, Zuber M, Pozzoli A, Nietlispach F, Tanner FC, Maisano F, et al. Tricuspid regurgitation: -assessment and new frontiers. Cardiovasc Med. 2017;20(9):203-8.

Nishimura RA, Otto CM. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:95-105.

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Published

2021-02-25

How to Cite

Surabhi, P. S., Tadiboina, A., Kumar, R. V., & Dev, T. R. (2021). Post-operative results of tricuspid annuloplasty with teflon felt. International Journal of Research in Medical Sciences, 9(3), 847–853. https://doi.org/10.18203/2320-6012.ijrms20210889

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Original Research Articles