Tricuspid Anteroposterior Patch Repair: Optimization of Patch Geometry in an Ex Vivo Model

Background: 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. Methods: 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 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. Conclusions: 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.