Abstract 17063: Pericardial Patch Augmentation of the Anterior and Posterior Tricuspid Leaflets Relieves Leaflet Tethering and Improves Coaptation in an Acute Porcine Model

Background: Tricuspid annuloplasty is generally effective in treating functional tricuspid regurgitation (TR), but patients with severe annular dilation or leaflet tethering have a high risk of recurrence.

Hypothesis: We hypothesized that anterior and posterior patch augmentation (APA) of the tricuspid valve (TV) would reduce leaflet tethering, improve coaptation, and effectively treat TR.

Methods: We evaluated APA repair in an acute porcine model. The TV was accessed via a right thoracotomy and cardiopulmonary bypass (CPB) was initiated with bicaval venous and ascending aortic cannulation. The anterior and posterior TV leaflets were separated from the annulus, and a 1.5 cm wide partial reverse frustum-shaped pericardial patch was implanted. 3D transepicardial echocardiography was used to image the TV pre- and post-implantation. Geometric measurements were assessed using Tomtec and compared with paired t-tests.

Results: APA repair was performed in five pigs (weight 60-80 kg). All animals were weaned from CPB in sinus rhythm. TR was trace or absent in all cases after APA repair. There were no changes in pressure gradient (0.5 vs 0.5, p>0.9) or annular area (11.2 vs 10.1 cm ² , p=0.19). APA repair was associated with a decreased tenting height and angle of the anterior (height: 9.0 vs 4.6 mm, p=0.03; angle: 20.9° vs 16.1°, p=0.04) and posterior (height: 9.8 vs 5.5 mm, p=0.03; angle: 28.1° vs 21.8°, p=0.03) leaflets. Central coaptation length increased in all leaflets (septal: 3.8 vs 6.6 mm, p=0.04, anterior: 4.7 vs 12.7 mm, p<0.01, posterior: 4.5 vs 13.2 mm, p<0.01).

Conclusions: APA repair was feasible, safe, reduced leaflet tenting, and improved coaptation. This novel repair method shows promise for patients with severe annular dilation or leaflet tethering who otherwise have a high risk of recurrence with annuloplasty alone. Furthermore, by avoiding suture placement near the conduction system, it may reduce the risk of post-operative conduction abnormalities.