Tricuspid valve repair: A rational alternative

Background and aims of the study: The prosthetic ring annuloplasty and inco mpletely encircling suture techniques are effective methods of tricuspid va lve repair when the problem is only annular dilatation, but not when organi c tricuspid valve disease is present. A surgical technique of valve repair has been developed that is equally effective in correcting purely functiona l as well as organic valvular incompetence. Methods: The Manipal method of repairing the incompetent tricuspid valve co nsists of three steps: (i) anteroseptal commissurotomy and asymmetric 'U-on -side' suture annuloplasty, to push the plane of coaptation of the anterior and septal leaflets into the right ventricle; (ii) a semicircular De Vega- type of plicating suture through the annulus, starting and ending just ceph alad to the posteroseptal commissure and extending anticlockwise to a point just caudal to the meridian, to exclude the posterior leaflet; and (iii) t ying the plicating suture after positioning a 3M Starr-Edward valve sizer a cross the tricuspid valve (in an adult), to ensure that the valve orifice i s not excessively narrowed. Results: Between July 1986 and January 1997, the Manipal method was used to repair 52 tricuspid valves, always combined with surgery for the mitral an d/or aortic valve. Tricuspid stenosis of varying degree was present in 61% of cases. One of two hospital deaths was related to the repaired valve. Alt hough the proportion of patients followed up fell progressively to 33% at 1 0 years, none of the patients either seen personally or who had replied to a postal questionnaire (78% of total patients) required reoperation for val ve regurgitation or obstruction. No patient had more than mild tricuspid re gurgitation clinically, even seven and 10 years after tricuspid valve repai r surgery. Conclusion: This alternative method of tricuspid valve repair is simple to execute, is equally effective in correcting both pure tricuspid regurgitati on and organic tricuspid valve disease, and appears to be extremely stable.