Papillary muscle approximation in chronic ovine functional tricuspid regurgitation.

Autor:	Gaweda B; Division of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Mich; Department of Cardiac Surgery, Faculty of Medicine, Clinical District Hospital No. 2, University of Rzeszow, Rzeszow, Poland., Gaddam M; Department of Urology, Stanford University School of Medicine, Stanford, Calif., Jaźwiec T; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Disease, Medical University of Silesia in Katowice, Zabrze, Poland., Bush JD; Research Department, Corewell Health, Grand Rapids, Mich., MacDougall B; Research Department, Corewell Health, Grand Rapids, Mich., Widenka K; Department of Cardiac Surgery, Faculty of Medicine, Clinical District Hospital No. 2, University of Rzeszow, Rzeszow, Poland., Timek TA; Division of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Mich; College of Human Medicine, Michigan State University, Grand Rapids, Mich. Electronic address: Tomasz.Timek@corewellhealth.org.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2023 Dec; Vol. 166 (6), pp. e502-e509. Date of Electronic Publication: 2023 Jun 16.
DOI:	10.1016/j.jtcvs.2023.05.039
Abstrakt:	Objective: Isolated tricuspid ring annuloplasty remains the surgical standard for functional tricuspid regurgitation repair but offers suboptimal results when right ventricular dilation and remodeling along with papillary muscle displacement is present. Addressing subvalvular remodeling with papillary muscle approximation may improve clinical outcomes. Methods: Functional tricuspid regurgitation and biventricular dysfunction were induced in 8 healthy sheep by rapid ventricular pacing (200-240 bpm) for 27 ± 6 days. Subsequently, animals underwent cardiopulmonary bypass for implantation of sonomicrometry crystals on the tricuspid annulus, right ventricle, and papillary muscle tips. Papillary approximation sutures were anchored between anterior-posterior and anterior-septal papillary muscles and externalized through right ventricular free wall to epicardial tourniquets. After weaning from cardiopulmonary bypass, sequential papillary muscle approximations were performed. Simultaneous hemodynamic, sonomicrometry, and echocardiographic data were collected at baseline and after each papillary muscle approximation. Results: With rapid pacing, right ventricular fractional area change decreased from 59 ± 6% to 38 ± 8% (P < .001), whereas tricuspid annulus diameter increased from 2.4 ± 0.3 cm to 3.3 ± 0.6 cm (P = .003). Tricuspid regurgitation (0-4+) increased from +0 ± 0 to +3.3 ± 0.7 (P < .001). Both anterior-posterior and anterior-septal papillary muscle approximation significantly reduced functional tricuspid regurgitation from +3.3 ± 0.7 to +2 ± 0.5 and +1.9 ± 0.6, respectively (P < .001). Reduction of tricuspid insufficiency with both subvalvular interventions was associated with decreased distance of the anterior papillary muscle to the annular centroid. Conclusions: Papillary muscle approximations were effective in reducing severe ovine functional tricuspid regurgitation associated with right ventricular dilation and papillary muscle displacement. Further studies are needed to evaluate efficacy of this adjunct to ring annuloplasty in repair of severe functional tricuspid regurgitation. (Copyright © 2023. Published by Elsevier Inc.)
Databáze:	MEDLINE
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