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Right ventricular papillary muscle approximation as a novel technique of valve repair for functional tricuspid regurgitation in an ex vivo porcine model

Yamauchi, Haruo, MD, PhD ; Vasilyev, Nikolay V., MD ; Marx, Gerald R., MD ; Loyola, Hugo, MS ; Padala, Muralidhar, PhD ; Yoganathan, Ajit P., PhD ; del Nido, Pedro J., MD

The Journal of thoracic and cardiovascular surgery, 2012-07, Vol.144 (1), p.235-242 [Periódico revisado por pares]

New York, NY: Mosby, Inc

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Título:
Right ventricular papillary muscle approximation as a novel technique of valve repair for functional tricuspid regurgitation in an ex vivo porcine model
Autor: Yamauchi, Haruo, MD, PhD ; Vasilyev, Nikolay V., MD ; Marx, Gerald R., MD ; Loyola, Hugo, MS ; Padala, Muralidhar, PhD ; Yoganathan, Ajit P., PhD ; del Nido, Pedro J., MD
Assuntos: Analysis of Variance ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Animals ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Echocardiography, Three-Dimensional ; Endocardial and cardiac valvular diseases ; Heart ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Heart Ventricles - surgery ; In Vitro Techniques ; Medical sciences ; Models, Animal ; Papillary Muscles - diagnostic imaging ; Papillary Muscles - physiopathology ; Papillary Muscles - surgery ; Pneumology ; Swine ; Tricuspid Valve Insufficiency - diagnostic imaging ; Tricuspid Valve Insufficiency - physiopathology ; Tricuspid Valve Insufficiency - surgery
É parte de: The Journal of thoracic and cardiovascular surgery, 2012-07, Vol.144 (1), p.235-242
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SourceType-Scholarly Journals-1
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Descrição: Objectives Annuloplasty for functional tricuspid regurgitation may sometimes be ineffective because of chamber dilation and valve tethering. This study compared a novel technique, right ventricle (RV)–papillary muscle approximation, with annuloplasty in experimentally-produced tricuspid regurgitation. Methods RVs of isolated porcine hearts (n = 10) were statically pressurized, which led to RV dilation and central tricuspid regurgitation. Regurgitant flow was measured with a saline solution–filled column. The head of the anterior papillary muscle was approximated to 4 points on the ventricular septum. Next, a prosthetic ring was implanted, and then RV–papillary muscle approximation was combined. Tricuspid annular dimension, RV geometry, and tricuspid valve tethering were analyzed with 3-dimensional echocardiography. Results Tricuspid regurgitation (2270 ± 186 mL/min) was reduced by RV–papillary muscle approximation alone (214 ± 45 mL/min; P < .05) more than by annuloplasty alone (724 ± 166 mL/min; P < .05). Combined RV–papillary muscle approximation and annuloplasty resulted in the least regurgitation (80 ± 39 mL/min). RV–papillary muscle approximation reduced tricuspid septolateral diameter (25%; P < .05), and annular area (23%; P < .05), as did annuloplasty. RV–papillary muscle approximation also reduced RV sphericity index (33%; P < .05) and tricuspid tethering height (54%; P < .05), whereas annuloplasty did not. Direction of RV–papillary muscle approximation did not independently affect outcomes. Conclusions This ex vivo study suggests that RV–papillary muscle approximation potentially repairs tricuspid regurgitation better than annuloplasty by improving ventricular sphericity and valve tethering as well as annular dimension.
Editor: New York, NY: Mosby, Inc
Idioma: Inglês

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Right ventricular papillary muscle approximation as a novel technique of valve repair for functional tricuspid regurgitation in an ex vivo porcine model

Yamauchi, Haruo, MD, PhD ; Vasilyev, Nikolay V., MD ; Marx, Gerald R., MD ; Loyola, Hugo, MS ; Padala, Muralidhar, PhD ; Yoganathan, Ajit P., PhD ; del Nido, Pedro J., MD

New York, NY: Mosby, Inc

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