Tricuspid valve repair for severe tricuspid regurgitation with a coaptation gap: anterior leaflet augmentation with a polytetrafluoroethylene patch

Objective In severe functional tricuspid regurgitation (TR), a coaptation gap may persist during systole, making isolated annuloplasty insufficient. We evaluated the durability of anterior leaflet augmentation with a polytetrafluoroethylene (PTFE) patch, especially in patients with massive or torrential TR. Methods Between April 2014 and March 2023, 20 of 593 (3%) TR patients who underwent tricuspid valve repair had severe-to-torrential TR with a coaptation gap. In this single-center retrospective study, we evaluated early- and mid-term survival and freedom from reoperation. No tricuspid valve replacement was performed in any of these 20 patients. We performed annuloplasty with 3-dimensional rigid rings in addition to anterior leaflet augmentation for all patients. Concomitant procedures included mitral valve repair in 17 patients, Maze Ⅳ procedure in 16 patients, and atrial plication in 15 patients. Results The mean age was 76.6 ± 4.5 years. Preoperative echocardiogram showed severe annular dilatation (45.0 ± 9.1 mm on apical 4-chamber view), and 14 patients had greater-than-severe TR (massive in 7, torrential in 7). There was no 30-day mortality, but 4 late deaths were observed during the follow-up period of up to 11.5 years after surgery (median: 50 months, IQR: 25.5–104.5 months). Significant recurrent TR developed in 1 patient because of an undersized patch but did not require reoperation. No tricuspid stenosis or tricuspid valve reoperation occurred. Conclusions Our technique for functional TR with a coaptation gap resulted in satisfactory mid-term outcomes. This technique may be useful to control TR, especially in patients with severe or greater-than-severe TR.