Larson Emily L, Rando Hannah, Rodriguez Emily, Quinn Rachael, Darby Zachary, Gammie James S
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg Short Rep. 2023 Dec 23;2(2):236-240. doi: 10.1016/j.atssr.2023.12.002. eCollection 2024 Jun.
Tricuspid anteroposterior patch (TRAPP) repair aims to address shortcomings of traditional annuloplasty in functional tricuspid regurgitation by selectively enlarging and translocating the anterior and posterior leaflets, but optimal patch width has not been identified.
An ex vivo model of the tricuspid valve was established in fresh porcine hearts by pneumatic pressurization of the ventricles. TRAPP repair was performed with patches of varying width (group 1, 1.0 cm; group 2, 1.5 cm; group 3, 2.0 cm). A 3-dimensional structured light scanner was used to image the topography of the tricuspid valve before and after TRAPP repair, and measurements were compared.
Coaptation length increased with TRAPP repair in all groups (group 1, 44% [ = .004]; group 2, 70% [ < .001]; group 3, 82% [ = .002]). Coaptation increases in length and area were similar in groups 2 and 3, but the larger patch size of group 3 caused bulging above the annulus and significant changes in leaflet measurements.
Optimal patch size for TRAPP repair is 1.5 cm. This patch size maximally increased coaptation length but avoided abnormal systolic leaflet geometry (bulging) seen with the larger patch.
三尖瓣前后补片（TRAPP）修复术旨在通过选择性扩大和移位前后瓣叶来解决传统瓣环成形术在功能性三尖瓣反流中的不足，但尚未确定最佳补片宽度。
通过对心室进行气动加压，在新鲜猪心脏中建立三尖瓣的体外模型。使用不同宽度的补片进行TRAPP修复（第1组，1.0厘米；第2组，1.5厘米；第3组，2.0厘米）。在TRAPP修复前后，使用三维结构光扫描仪对三尖瓣的地形进行成像，并比较测量结果。
所有组在进行TRAPP修复后，瓣叶对合长度均增加（第1组，44%[P =.004]；第2组，70%[P <.001]；第3组，82%[P =.002]）。第2组和第3组在对合长度和面积增加方面相似，但第3组较大的补片尺寸导致瓣环上方隆起以及瓣叶测量值发生显著变化。
TRAPP修复的最佳补片尺寸为1.5厘米。该补片尺寸最大程度地增加了瓣叶对合长度，但避免了较大补片所见的异常收缩期瓣叶形态（隆起）。
