Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction Marc W. Gerdisch, MD, W. Douglas Boyd,

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Presentation transcript:

Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction Marc W. Gerdisch, MD, W. Douglas Boyd, MD, John L. Harlan, MD, John B. Richardson, MD, Joseph E. Flack, MD, Brian A. Palafox, MD, William E. Johnson, MD, Benjamin Sun, MD, Richard Lee, MD, T. Sloane Guy, MD, Gyu I. Gang, MD, James L. Cox, MD, Vivek Rao, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 6, Pages 3042-3048 (December 2014) DOI: 10.1016/j.jtcvs.2014.06.092 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Illustration depicting extracellular matrix cylinder implantation technique. A, Mattress sutures are placed in each of the 3 papillary attachment points. B, The extracellular matrix cylinder is tied down at 3 evenly spaced points, with the seam aligned with the septal papillary muscle. C, The proximal edge is sutured to the annulus in a circumferential fashion. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3042-3048DOI: (10.1016/j.jtcvs.2014.06.092) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Extracellular matrix tricuspid cylinder reconstruction technique. A and B, Placement of sutures in papillary attachment points. C, Extracellular matrix cylinder before implantation. D, The distal edge of the cylinder is tied down to the attachment points. E, The cylinder's proximal edge is sutured circumferentially to the annulus. F, Completed repair showing valve competence under saline insufflation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3042-3048DOI: (10.1016/j.jtcvs.2014.06.092) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Postoperative echocardiogram showing completed valve reconstruction and neoleaflet coaptation. RA, Right atrium; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3042-3048DOI: (10.1016/j.jtcvs.2014.06.092) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Possible placement of sutures in the tricuspid valve annulus during cylinder reconstruction (red lines). A, Recommended placement. At the level of the annulus, the triangle of Koch is avoided and the atrioventricular node–His bundle complex is quite deep, protecting it from interference by the sutures. B, Sutures placed along the tendon of Todaro around the atrioventricular node or placed deeply where the bundle of His traverses into the ventricular septum have the potential to create heart block and should be avoided. AV, Atrioventricular. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3042-3048DOI: (10.1016/j.jtcvs.2014.06.092) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions