Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction

Objective The short-term outcomes were evaluated in patients treated for tricuspid valve endocarditis using a novel extracellular matrix (ECM) cylinder reconstruction technique. Methods Patients with clinically significant tricuspid regurgitation whose valves were not repairable by conventional tech...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2014-12, Vol.148 (6), p.3042-3048
Main Authors: Gerdisch, Marc W., MD, Boyd, W. Douglas, MD, Harlan, John L., MD, Richardson, John B., MD, Flack, Joseph E., MD, Palafox, Brian A., MD, Johnson, William E., MD, Sun, Benjamin, MD, Lee, Richard, MD, Guy, T. Sloane, MD, Gang, Gyu I., MD, Cox, James L., MD, Rao, Vivek, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Bioprosthesis
Cardiothoracic Surgery
Endocarditis, Bacterial - complications
Endocarditis, Bacterial - diagnosis
Endocarditis, Bacterial - microbiology
Endocarditis, Bacterial - surgery
Extracellular Matrix - transplantation
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - instrumentation
Heart Valve Prosthesis Implantation - methods
Humans
Male
Middle Aged
Prosthesis Design
Reconstructive Surgical Procedures - adverse effects
Reconstructive Surgical Procedures - instrumentation
Reconstructive Surgical Procedures - methods
Retrospective Studies
Suture Techniques
Time Factors
Treatment Outcome
Tricuspid Valve - diagnostic imaging
Tricuspid Valve - microbiology
Tricuspid Valve - surgery
Tricuspid Valve Insufficiency - diagnosis
Tricuspid Valve Insufficiency - microbiology
Tricuspid Valve Insufficiency - surgery
Ultrasonography
Young Adult
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Summary:Objective The short-term outcomes were evaluated in patients treated for tricuspid valve endocarditis using a novel extracellular matrix (ECM) cylinder reconstruction technique. Methods Patients with clinically significant tricuspid regurgitation whose valves were not repairable by conventional techniques underwent valve replacement with a cylindrical construct sewn out of CorMatrix ECM (CorMatrix Cardiovascular, Roswell, Ga). The cylinders were sized to the native valve dimensions and attached distally to the papillary muscles using polypropylene sutures and ECM pledgets, and proximally to the annulus using a running suture. Patient data were collected retrospectively. Results From November 2011 to October 2013, 12 surgeons performed 19 tricuspid valve cylinder reconstructions in 8 men and 10 women (age range, 19-53 years). Of the 19 patients, 11 had active and 5 had treated endocarditis. One case was robotic-assisted. No deaths occurred, and no new cases of heart block developed. The papillary attachments were disrupted intraoperatively in 1 patient and after 7 days in another; both were successfully revised. A third patient experienced recurrent disruption of the implant at 13 and 22 months and ultimately received a pericardial valve. Fungal infection occurred in 1 cylinder at 6 months; a second ECM cylinder was implanted. Follow-up data were available for 13 patients at 1 to 2 months, 8 at 6 months, and 3 at 12 and 18 months. Other than patients undergoing reoperation, all showed well-functioning tricuspid valves with no to mild regurgitation. Conclusions Cylinder reconstruction with ECM could be a suitable technique for replacing the tricuspid valve while preserving annuloventricular continuity in patients with infective endocarditis not repairable by conventional techniques.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2014.06.092