Tricuspid autograft for mitral-valve repair.

Hvass U, Juliard J M, Assayag P, Laperche T, Pansard Y, Chatel D

Cardiovascular Surgery and Department of Cardiology, Hôpital Bichat, Paris 75018, France.

Lancet. 1996 Mar 9;347(9002):659-61. doi: 10.1016/s0140-6736(96)91206-4.

BACKGROUND

Transferring the posterior leaflet of the patient's own tricuspid valve with its subvalvular apparatus to the mitral valve is a new technique that allows a conservative approach to mitral-valve repair. The technique is based on the knowledge that the tricuspid valve can be remodelled from tricuspid to bicuspid, with a very low risk of significant dysfunction.

METHODS

We describe six patients (age range 20-70 years) with mitral insufficiency in whom we have used the technique.

FINDINGS

All patients survived the operation and were in sinus rhythm. Transoesophageal echocardiography before discharge showed trivial or no regurgitation at the site of mitral repair. Before operation, all patients were in New York Heart Association class III-IV; at follow-up after 6-13 months all patients were in class I-II.

INTERPRETATION

Compared with using segments of mitral homografts in similar situations, the intraoperative availability of the tricuspid's viable natural chordae and valvular leaflet means that there are no immunological disadvantages to the procedure. With this new operation, the patient is his own tissue bank.