Redo Tricuspid Valve Construction With CorMatrix

Recurrent tricuspid valve endocarditis is a difficult problem that is not uncommon. Valvectomy is often used as a temporizing strategy until remission from drug abuse is achieved for a meaningful time. In the absence of a tricuspid valve, timing of reintervention is crucial and should precede severe irreversible right ventricle failure.

Upon intervention, every effort should be made to avoid implanting prosthetic materials. Available options to achieve this are either the use of the autologous fresh pericardium technique, or the CorMatrix tube technique (1, 2).

The former is a technique where nonfixed autologous pericardium is used to construct a valve in the mitral morphology, and neochords are used for subvalvular continuity. While this technique is feasible and showed promising short term results, the availability and quality of enough autologous pericardium upon re-entry in a multi-redo setting is uncertain. Long term results of this technique are still unknown.

The CorMatrix is an acellular extracellular matrix bioscaffold that has been used in a tube fashion to create a valve structure. Early animal studies showed promising host cellular infiltration of the matrix and progressive tissue remodeling (3). The CorMatrix tube technique for tricuspid valve reconstruction has an accumulating body of in vivo results and does not depend on the availability of autologous pericardium. Some refinement of surgical techniques has been adopted to prevent some of the reported early failures. The authors present a step-by-step video of the CorMatrix tube technique in a third reoperative setting.

References

1. Bedeir K. A New Technique for De Novo Tricuspid Valve Construction Using Autologous Pericardium. Ann Thorac Surg. 2023 Jan;115(1):e5-e7. doi: 10.1016/j.athoracsur.2022.02.038. Epub 2022 Mar 5. PMID: 35257673.
2. Gerdisch MW, Shea RJ, Barron MD. Clinical experience with CorMatrix extracellular matrix in the surgical treatment of mitral valve disease. J Thorac Cardiovasc Surg. 2014 Oct;148(4):1370-8. doi: 10.1016/j.jtcvs.2013.10.055. Epub 2013 Dec 9. PMID: 24332188.
3. Fallon AM, Goodchild TT, Cox JL, Matheny RG. In vivo remodeling potential of a novel bioprosthetic tricuspid valve in an ovine model. J Thorac Cardiovasc Surg. 2014 Jul;148(1):333-340.e1. doi: 10.1016/j.jtcvs.2013.10.048. Epub 2013 Dec 19. PMID: 24360254.

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