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Background: Isolated tricuspid valve prolapse (TVP) is an uncommon valvular defect. TVP can be associated with congenital lack or traumatic rupture of chordae tendineae, rupture of papillary muscle or leaflet tear, and mitral valve prolapse. Minimally invasive robotic assisted repair of TVP is not a routine procedure. We present the case of a minimally invasive robotic assisted repair of TVP for high-grade tricuspid regurgitation.
Methods: The da Vinci Surgical System® (Intuitive Surgical, Inc., Sunnyvale, CA) was employed to complete minimally invasive repair of a prolapsed tricuspid valve. Operative technique consisted of a 4cm right anterolateral thoracotomy working port in the 4th intercostal space as well as right and left da Vinci Surgical System® arm ports in the 2nd and 5th intercostal spaces respectively. Carbon dioxide insufflation was used, following which cardiopulmonary bypass was initiated through femoral cannulation. The aorta was cross-clamped and cold blood antegrade cardioplegia was administered. A right atriotomy perpendicular to the atrioventricular groove was fashioned, and the robotic assisted tricuspid valve repair was completed.
Results: Intraoperatively a flail anterior tricuspid leaflet unsupported by chordae tendineae was found. Gore-Tex® neochordae (W. L. Gore & Associates, Flagstaff, AZ) were used to attach the anterior leaflet to the anterior papillary muscle with Gore-Tex® CV-4 sutures. Mild prolapse was observed at the commissure of the anterior and posterior leaflets and along the posterior leaflet. One additional Gore-Tex® neochordae was placed from the free edge of the anterior and posterior leaflets to the posterior papillary muscle. A saline test confirmed valve competence. A 31mm Tailor® annuloplasty band (St. Jude Medical Inc, Minneapolis, MN) was placed around the tricuspid annulus for additional support. The patient was extubated in less than 12 hours following surgery, and was discharged the morning of postoperative day four.
Conclusions: Incidence of isolated tricuspid valve regurgitation is <1% in the US, and subsequent TVP occurs in up to 3% of cases. Tricuspid valve repair with annuloplasty can be successfully achieved by minimally invasive techniques, and should be considered when appropriate.