Eur J Cardiothorac Surg 2005;27:934-935
© 2005 Elsevier Science NL
Reply to Castedo et al.
Michele De Bonis*,
Ottavio Alfieri
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
Received 1 February 2005;
accepted 7 February 2005.
* Corresponding author. Tel.: +39 02 2643 7102; fax: +39 02 2643 7125. (E-mail: michele.debonis{at}hsr.it).
Key Words: Tricuspid regurgitation • ‘Edge-to-edge’ technique • Tricuspid repair
We would like to thank Castedo and co-workers for the contribution given with this letter to the interesting discussion about tricuspid repair in presence of complex lesions. We are aware of the cases of redeveloped tricuspid valve incompetence, after previous De Vega's annuloplasty, successfully treated in their institution with the ‘edge-to-edge’ technique [1]. We agree with them that this approach certainly represents a useful option in different types of tricuspid regurgitation. As reported by Maisano [2], our group started to use the ‘edge-to-edge’ technique for tricuspid repair in the early nineties, in presence of post-traumatic tricuspid insufficiency. Afterwards, we extended its application also to a few cases of degenerative tricuspid regurgitation with satisfactory outcomes. The ‘clover’ technique [3,4], in our opinion, represents a step forwards in the surgical treatment of tricuspid regurgitation due to multiple leaflet prolapse or flail or marked tethering of the tricuspid cusps secondary to dilated cardiomyopathy. In 2002, Gateliene already described a ‘triple orifice tricuspid repair’ [5] which seems to be very close to the ‘clover’ procedure reported by us, although its technical details are rather unclear being the article entirely written and published in Lithuanian. Compared to the tricuspid bicuspidalization associated to the ‘edge-to-edge’ repair, the ‘clover’ technique preserves the three leaflet configuration of the tricuspid valve and leaves a larger valve area which represents the sum of the three new orifices created. In our experience, this approach allowed a successful repair in cases in which both conventional techniques as well as the ‘classical edge-to-edge’ seemed unable to restore the competence of the valve. As far as the concomitant annuloplasty concerns, we recommend it in all cases of ‘clover’ repair. So far we have been using a ring annuloplasty in most of the patients with very dilated annulus but a De Vega suture annuloplasty has been adopted as well when the severity of the annular enlargement was less pronounced.
References
- Castedo E, Cañasj A, Cabo RA, Burgos R, Ugarte J. Edge-to-edge tricuspid repair for redeveloped valve incompetence after De Vega's annuloplasty. Ann Thorac Surg 2003;75:605-606.[Abstract/Free Full Text]
- Maisano F, Lorusso R, Sandrelli L, Torracca L, Coletti G, La Canna G, Alfieri O. Valve repair for traumatic tricuspid regurgitation. Eur J Cardiothorac Surg 1996;10:867-873.[Abstract]
- Alfieri O, De Bonis M, Lapenna E, Agricola E, Quarti A, Maisano F. The ‘clover technique’ as a novel approach for correction of post-traumatic tricuspid regurgitation. J Thorac Cardiovasc Surg 2003;126:75-79.[Abstract/Free Full Text]
- De Bonis M, Lapenna E, La Canna G, Grimaldi A, Maisano F, Torracca 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(5):760-765.[Abstract/Free Full Text]
- Gateliene E, Voluckiene E, Ivaskeviciene L, Uzdavinys G, Semetiene G. Early and late postoperative results of mitral and tricuspid valve insufficiency surgical treatment using edge-to-edge central coaptation procedure. Medicina (Kaunas) 2002;38(Suppl 2):172-175.
