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DOI: 10.1055/s-0035-1544556
Redo Tricuspid Valve Replacement with an Extracellular Matrix Cylinder in a Drug Abusing Patient with Infective Endocarditis
Introduction: Infective endocarditis in drug abusers is a challenging clinical problem. We report a case of using extracellular matrix to create a neo-tricuspid valve for redo tricuspid valve replacement to highlight certain technical aspects and pitfalls.
Background: Extracellular matrix (ECM) can be used for intracardiac repairs ranging from septal defect closure to annular patching after debridement/decalcification to repair of valvular pathology. Earlier this year, ECM was used to create a neo-tricuspid valve. The advantage of this approach is the regeneration of ECM into histologically normal tricuspid valve tissue.
Discussion: A 29 year old woman underwent bioprosthetic aortic and tricuspid valve replacement and Cor-matrix patch of an aorta-right atrium fistula 1 year ago. She presented to our institution with bioprosthetic tricuspid valve endocarditis with septic embolization to the lungs. After sterilization of the blood stream with antibiotics and preoperative optimization, the patient underwent redo sternotomy, and explantation of the tricuspid bioprosthesis. Cor-matrix extracellular matrix was fashioned into a cylinder, the height of which was 1.4 times the width. The caudal aspect of the cylinder was fixated in 3 points to 3 papillary muscles in the right ventricle. The cephalad aspect of the cylinder was fixated using 4–0 Prolene suture in 3 points to the tricuspid annulus corresponding to the locations of the commissures. These sutures were then run toward each other to complete the fixation to the tricuspid annulus. On separation from cardiopulmonary bypass, the tube was noted to be prolapsing into the right atrium. The right atrium was opened, and one of the papillary muscle anchoring stitches was noted to have disrupted the papillary muscle. As a result, the cylindrical tube was fixated to another papillary muscle this time using a felt pledget. Postoperative echocardiography showed only minimal TR, and follow-up echocardiography at 1 month shows stable minimal TR. The patient continues to do well clinically.