First In Canada Experience With A Combined Semi-Rigid/Flexible Ring For Minimally Invasive, Redo Beating-Heart Tricuspid Valve Repair And Percutaneous Venae Cavae Occlusion

MP022 

Case Video Submission 

Gianluigi Bisleri (1), Syed M. Ali Hassan (1), Ahmad Alli (1), Changqing Du (2), Corey Adams (3), Alexander J Gregory (3), William Kent (3)

(1) University of Toronto, Toronto, ON, (2) St. Michael's Hospital, Toronto, ON, (3) University of Calgary, Calgary, Alberta

Gianluigi Bisleri    -  Contact Me
University of Toronto

Syed M. Ali Hassan    -  Contact Me
University of Toronto

Ahmad Alli    -  Contact Me
University of Toronto

Changqing Du    -  Contact Me
St. Michael's Hospital

Corey Adams    -  Contact Me
University of Calgary

Alexander Gregory    -  Contact Me
University of Calgary

William Kent    -  Contact Me
University of Calgary

Gianluigi Bisleri    -  Contact Me
St. Michael’s Hospital

Objective: Isolated tricuspid valve surgical repair can be associated with a high risk of perioperative morbidity and mortality. The use of a beating heart approach has been described in order to potentially mitigate peri-operative right ventricular (RV) dysfunction. Furthermore, a re-operative setting can present significant challenges in achieving control of both vena cavae. We present a case of a minimally invasive, beating heart tricuspid valve surgical repair with use of Tri-Ad ring and percutaneous bicaval endovascular occlusion with CODA balloon catheters.

Case Video Summary: A 72 years old patient with previous CABG surgery was admitted due to severe tricuspid regurgitation (TR). Past medical history included : long-standing persistent atrial fibrillation, permanent pacemaker in 2017 for tachy-brady syndrome, obstructive sleep apnea. Pre-operative TEE showed severe TR mostly due to annular dilatation (6.1 cm) with no evidence of RV lead impingement, moderate RV dysfunction, dilated RV ventricle, RVSP = 55 mmHg, LVEF = 45-50%.
A minimally invasive procedure was planned via a right mini-thoracotomy: following cannulation of the SVC and IVC, CPB was instituted and both venae cavae were occluded by using a CODA balloon advanced beyond each respective cannulae. Under beating heart conditions, the right atrium was opened, excellent exposure of the TV was achieved: a Tri-AD ring size 32 was implanted. Post-repair TEE confirmed excellent result of the TV repair with no residual regurgitation and a mean gradient around 1 mmHg.


Conclusions: A minimally invasive, beating-heart strategy can represent a useful option for TV repair especially in the setting of a redo procedure: in particular, the use of a percutaneous venae cavae occlusion can minimize potential manipulation and avoid unneccesary risks during snaring. The Tri-Ad ring allowed for an effective TV annular remodeling even in presence of a significantly large annular dilatation (> 6 cm).

Tricuspid Valve Diseases & Therapies