Self-Constructed Tubular Heart Valve Using Bovine Pericardium for Surgical Treatment of Tricuspid Valve Endocarditis

Tricuspid valve endocarditis with extensive leaflet destruction presents a major surgical challenge, particularly when durable valve repair is no longer feasible and conventional prosthetic valve replacement may be undesirable. In this video, the authors demonstrate their technique for the surgical treatment of destructive tricuspid valve endocarditis using a self-constructed tubular valve fashioned from bovine pericardium.  

After radical debridement of all infected and devitalized tissue, the extent of valvular destruction was assessed. A tubular valve substitute was then constructed from bovine pericardium, tailored to the individual annular dimensions and created to provide a competent neo-valve while minimizing prosthetic material. The tubular pericardial valve was subsequently implanted at the tricuspid annulus using a standardized suture technique. Particular attention was paid to secure fixation, geometric alignment, and preservation of right ventricular inflow without stenosis. Intraoperative testing and echocardiographic assessment were used to confirm adequate competence and satisfactory hemodynamic function.  

This approach may represent a valuable surgical alternative in selected patients with severe tricuspid valve endocarditis, especially in the setting of extensive tissue destruction, active infection, or in patients for whom avoidance of conventional prosthetic valve replacement is preferred. The technique combines radical infective source control with biological reconstruction using bovine pericardium and may offer favorable hemodynamic performance in the low-pressure right-sided circulation. 

This video is the third-place winner of the CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the first and second place winners. 

References

1. Gerdisch MW, Boyd WD, Harlan JL, Richardson JB Jr, Flack JE 3rd, Palafax A, Johnson WE 3rd, Sun B, Lee R, Guy TS, Gang GY, Cox JL, Rao V. Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction. J Thorac Cardiovasc Surg. 2014;148(6):3042-3048. 
2. Parra VM, Fita G, Pomar JL, Rovira I, Berrebi A, Sitges M. Assessment of tricuspid annulus: anatomic and echocardiographic correlation. Int J Cardiovasc Imaging. 2021;37(7):2189-2196. doi:10.1007/s10554-021-02188-1.

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