Outcomes of Tricuspid Valve Repair with Artificial Neochordae in Pediatric and Adult Patients.
Ann Thorac Surg 2022;
114:826-832. [PMID:
35149047 DOI:
10.1016/j.athoracsur.2022.01.027]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND
There is little data on outcomes following expanded polytetrafluoroethylene artificial neochordae (ePTFE-AN) for tricuspid valve (TV) repair. We evaluated outcomes after TV repair with ePTFE-AN in both pediatric and adult patients.
METHODS
We analyzed clinical data of 87 consecutive patients who underwent ePTFE-AN implantation at the time of TV repair from 1998 to 2020. Patients were categorized into pediatric and adult groups.
RESULTS
Twenty-nine (33.3%) were pediatric and 58 (66.7%) were adult patients. The most common etiology of tricuspid regurgitation (TR) was congenital (pediatrics: 86.2%, 25 of 29; adults: 39.7%, 23 of 59). Median number of pairs of ePTFE-AN implanted was 2 (interquartile range [IQR], 2-5) for pediatric and 3 (IQR, 2-4) for adult patients. There was no early death. Three adult patients (5.2%) required early TV reoperation; four (1 pediatric, 3 adults) underwent late TV reintervention. Etiology of TR was congenital in four of the six adults who required TV reintervention. Three-year cumulative risk of TV reintervention was 0.0% for pediatric and 7.3% (95% CI, 0.4-14.2%) for adult patients. There was significant improvement in TR grade after TV repair at dismissal and the latest echocardiographic follow-up in each group (P<.001). One pediatric and seven adult patients developed severe TR during follow-up, six of them underwent TV reoperation (1 pediatric, 5 adults).
CONCLUSIONS
ePTFE-AN implantation in the TV position can be performed safely and effectively with no early death. In adult patients with congenital TR, patient selection is critical to achieve durable outcome following TV repair.
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