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MP22. 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

Gianluigi Bisleri Poster Presenter
St. Michael’s Hospital
Toronto, ON 
Canada  - Contact Me

Dr. Gian Bisleri is Director of Minimally Invasive Cardiac Surgery at St. Michael’s Hospital, Associate Professor of Surgery at the University of Toronto, and Investigator at the Li Ka Shing Knowledge Institute. Dr. Bisleri has extensive expertise in the full spectrum of adult cardiac surgery with a special expertise in minimally invasive cardiac surgery: in particular, he has been focusing on developing less invasive approaches for cardiac valve repair and replacement as well as novel and advanced reconstruction techniques. Dr. Bisleri is also Surgical Director of the Structural Heart Program at St. Michael’s Hospital with direct involvement in percutaneous treatment of valve disease (mitral, aortic, tricuspid), either for transcatheter valve repair or replacement .

Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown 
Room: Grand Ballroom Foyer 

Description

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).

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