TITLE:
Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation
AUTHORS:
Kayo Sugiyama, Hirotaka Watanuki, Masato Tochii, Daisuke Koiwa, Katsuhiko Matsuyama
KEYWORDS:
Isolated Tricuspid Valve Surgery, Beating-Heart Surgery, Right Atrial Plication, Atrial Functional Tricuspid Valve Regurgitation, TRI-SCORE
JOURNAL NAME:
Open Journal of Thoracic Surgery,
Vol.13 No.2,
June
30,
2023
ABSTRACT: Background: Isolated tricuspid
valve disease remains a controversial indication for surgical intervention.
Many patients referred for surgery already have a poor clinical condition and
an advanced New York Heart Association functional class. There is no consensus
on the optimal surgical technique for this condition, including on whether to
perform the procedure on a beating or an arrested heart and whether to perform
valve repair or replacement. Methods: We analyzed four case series
between 2015 and 2022 in which patients with secondary tricuspid regurgitation
(TR) underwent valve repair on a beating heart
and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All
patients experienced a favorable postoperative course with significant
improvements in heart failure symptoms. TR was markedly reduced;
however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the
late phase. Conclusions: Tricuspid valve repair on a beating heart was
effective for improving the cardiac function, and the TRI-SCORE proved useful
as a preoperative risk assessment tool. The underlying mechanism by which TR
exacerbates MR requires further investigation.