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Eur J Cardiothorac Surg 2005;27:933-934
© 2005 Elsevier Science NL

Letter to the Editor

Edge-to-edge technique for correction of tricuspid valve regurgitation due to complex lesions

Evaristo Castedo*, Emilio Monguio, Ruben A. Cabo, Juan Ugarte

Department of Cardiothoracic Surgery, Clinica Puerta de Hierro, San Martin de Porres 4, 28035 Madrid, Spain

Received 3 January 2005; accepted 7 February 2005.

* Corresponding author. Tel.: +34 91 3735979; fax: +34 91 3730535. (E-mail: evaristocm{at}terra.es).

Key Words: Tricuspid regurgitation • Valve repair

I read with great interest the article by De Bonis and colleagues [1] in the May 2004 issue of EJCTS. They report excellent functional and clinical results with a novel technique for correction of severe tricuspid valve regurgitation due to complex lesions like prolapse or flail of multiple cusps. The surgical approach consisted of stitching together the middle point of the free edges of the three tricuspid leaflets producing a clover shaped valve (‘clover technique’) in combination with annuloplasty.

This surgical procedure represents an extension of application criteria of the well-established edge-to-edge valve repair method that was first successfully applied by the group of Alfieri for the treatment of mitral regurgitation [2]. The idea of performing an edge-to-edge tricuspid repair is not new, as it was previously reported by Maisano [3] and Mantovani [4] for the correction of traumatic and congenital tricuspid regurgitation. In February 2003, we also reported the successful management of redeveloped tricuspid valve incompetence after previous DeVega's annuloplasty by using a combination of bicuspidalization annuloplasty and the edge-to-edge technique [5]. Tricuspid bicuspidalization was achieved by posterior leaflet plication, and a double valve orifice was obtained by approximation of the free edges of the septal and the new created anteroposterior leaflets. This approach is very effective in dealing with complex acquired tricuspid regurgitation, especially in patients with severe tethering effect and great annulus diameter in which annuloplasty was previously performed. De Bonis and colleagues did not mention in their article this previous report of what we consider a surgical variant of the so called ‘the clover technique’. Instead of implanting a prosthetic ring, we preferred to perform a bicuspidalization annuloplasty, which is simpler, less time-consuming and avoids passing sutures through the anterior annulus, which may be a tough procedure in reoperated cases with previous DeVega's annuloplasty.

References

  1. De Bonis M, Lapenna E, La Canna G, Grimaldi A, Maisano F, Torraca L, Caldarola A, Alfieri O. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions. Eur J Cardiothorac Surg 2004;25:760-765.[Abstract/Free Full Text]
  2. Fucci C, Sandrelli L, Pardini A, Torracca L, Ferrari M, Alfieri O. Improved results with mitral valve repair using new surgical techniques. Eur J Cardiothorac Surg 1995;9:621-627.[Abstract]
  3. Maisano F, Lorusso R, Sandrelli L, Torraca L, Coletti G, La Canna G, Alfieri O. Valve repair for traumatic tricuspid regurgitation. Eur J Cardiothorac Surg 1996;10:867-873.[Abstract]
  4. Mantovani V, Grossi C, Ferrarese S, Sala A. Edge-to-edge repair of congenital familiar tricuspid regurgitation: case report. J Heart Valve Dis 2000;9:641-643.[Medline]
  5. Castedo E, Cañas A, Cabo RA, Burgos R, Ugarte J. Edge-to-edge tricuspid repair for redeveloped valve incompetence after DeVega's annuloplasty. Ann Thorac Surg 2003;75:605-606.[Abstract/Free Full Text]




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