Mitral Valve Repair Reference Center at The Mount Sinai Hospital Mount Sinai

Rationale and Initial Experience With the Tri-Ad Adams Tricuspid Annuloplasty Ring

 

The Journal of Thoracic and Cardiovasculuar Surgery

Volume 143, Number 4S, April 2012, Pages S71-S73

 

Federico Milla, MD, Javier G. Castillo, MD, Robin Varghese, MD, Joanna Chikwe, MD, Anelechi C. Anyanwu, MD, and David H. Adams, MD

 

Controversy exists regarding the indication and method of repair of functional tricuspid regurgitation (TR) in patients undergoing mitral valve surgery. Whereas the American College of Cardiology/American Heart Association guidelines recommend tricuspid repair in the setting of severe TR, tricuspid repair is advised for less than severe TR in the setting of annular dilation or pulmonary hypertension. Although multiple repair strategies exist, the use of a ring annuloplasty (semirigid remodeling rings vs flexible bands) is the preferred method of therapy to avoid short- and long-term recurrence of TR. The new Tri-Ad Adams annuloplasty ring combines elements of semirigid and flexible bands that will not only allow for annular remodeling in the region of the right ventricular free wall but also potentially reduce injury to the conduction system with its flexible and "open" ends. In this article, we discuss the rational for an aggressive approach to functional tricuspid regurgitation, and show our initial clinical experience with the Tri-Ad Adams annuloplasty ring.

 

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Functional Tricuspid Regurgitation in Mitral Valve Disease: Epidemiology and Prognostic Implications

 

Seminars in Thoracic and Cardiovascular Surgery

Volume 22, Issue 1, Spring 2010, Pages 69-75

 

Anelechi C. Anyanwu and David H. Adams

 

In this review we summarize the data on epidemiology and natural history of functional tricuspid valve regurgitation as it applies to surgery for mitral valve disease. Tricuspid regurgitation in the context of mitral valve disease is frequent and is associated with substantial reduction in survival and quality of life. In many patients, the correction of left-sided cardiac lesions does not lead to resolution of tricuspid regurgitation. Significant tricuspid regurgitation after mitral valve surgery portends a poor prognosis, a course that is often not altered by subsequent surgical therapy. Although a liberal approach to tricuspid annuloplasty is widely practiced, the evidence that this approach alters the natural history of functional tricuspid regurgitation is not yet available, so it is not certain how much of the negative impact of tricuspid regurgitation is causative, rather than confounding, and to what degree we will improve long-term outcomes of mitral valve surgery by liberal tricuspid annuloplasty.

 

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Tricuspid Valve Repair for Treatment and Prevention of Secondary Tricuspid Regurgitation in Patients Undergoing Mitral Valve Surgery.

 

Ani C. Anyanwu, Joanna Chikwe, and David H. Adams

 

Current Cardiology Reports; Volume 10, Issue 2, March 2008, Pages 110-117

 

Secondary or functional tricuspid regurgitation occurring late after mitral valve surgery is associated with high morbidity and mortality. In this article, we review the pathophysiology of secondary tricuspid regurgitation and the evidence supporting the use of tricuspid valve annuloplasty for preventing and treating secondary tricuspid regurgitation. Liberal application of tricuspid valve annuloplasty is recommended to prevent progression of secondary regurgitation, as contrary to widely held opinion, fixing the left-sided valve dysfunction often does not resolve secondary tricuspid valve dysfunction. Based on existing literature, assessing the tricuspid valve annular dimensions can be recommended as part of all mitral valve operations, and annuloplasty strongly considered in patients with tricuspid annular dilatation or moderate to severe tricuspid regurgitation.

 

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Surgical Management of Functional Tricuspid Regurgitation with a New Remodeling Annuloplasty Ring

 

Farzan Filsoufi, Sacha P. Salzberg, Vivian Abascal, David H. Adams

 

The Mount Sinai Journal of Medicine ; Volume 73, Number 6, October 2006, Pages 874-879

 

Moderate-to-severe functional tricuspid regurgitation (TR) should be corrected in patients undergoing surgery for left-sided valvular diseases, to improve long-term outcomes. Several techniques of surgical repair (suture annuloplasty or prosthetic annuloplasty) to correct this condition have been described. Multiple clinical studies have shown the superiority of prosthetic remodeling annuloplasty over the other surgical approaches.

 

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A Three-Dimensional Ring Annuloplasty for the Treatment of Tricuspid Regurgitation

 

Farzan Filsoufi, Sacha P. Salzberg, Marianne Coutu and David H. Adams

 

The Annals of Thoracic Surgery; Volume 81, Issue 6, June 2006, Pages 2273-2277

 

Significant functional tricuspid regurgitation should be corrected in patients undergoing surgery for left-sided valvular diseases. Several clinical studies have shown the superiority of the remodeling annuloplasty over other repair techniques. Herein we report our early experience with a new three-dimensional remodeling prosthetic ring (Edwards MC3 annuloplasty system).

 

 

Optimal Surgical Management of Severe Tricuspid Regurgitation in Cardiac Transplant Patients

 

Farzan Filsoufi MD, Sacha P. Salzberg MD, Curtis A. Anderson MD, Gregory S. Couper MD, Lawrence H. Cohn MD and David H. Adams MD

 

The Journal of Heart and Lung Transplantation, Volume 25, Issue 3, March 2006, Pages 289-293

 

Severe tricuspid regurgitation (TR) with signs of right-sided heart failure is rare after orthotopic heart transplantation (OHT). In some instances, this condition will require surgical correction using reconstructive surgery or prosthetic valve replacement. Repair techniques of atrioventricular valves are now well described. However, the results of the different surgical procedures in this setting have not been widely reported and may depend on the type of valvular dysfunction and lesions present. Herein we report our experience in a group of patients requiring surgical correction of symptomatic severe TR after OHT.

 

 

Long-term outcomes of tricuspid valve replacement in the current era.

 

The Annals of Thoracic Surgery, Volume 80, Issue 3, September 2005, Pages 845-850

 

Farzan Filsoufi MD, Ani C. Anyanwu MD, Sacha P. Salzberg MD, Tim Frankel MD, Lawrence H. Cohn MD and David H. Adams MD

 

Regardless of the indication, tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity. We report the results of our experience in a high-risk patient population with an emphasis on operative mortality, long-term survival, and valve related events according to the type of prosthesis.

 

Page Created: Tuesday, 23 October 2007

Last Updated: Tuesday, 03 April 2012

 

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