Discussion
In most cases, the TV incompetence is mild and requires no surgical
therapy at the time of TAC correction. If the TV incompetence is
moderate or severe, correction is necessary. A TV replacement with a
mechanical prosthesis or a homograft, although technically feasible
because of the usually large valvular ring, is associated with a higher
morbidity and mortality due to requirement of lifelong anticoagulation
and/or reoperations.
An alternative to replacement is TV reconstruction; this option is more
challenging and not performed as often. Naimo et al. reported 14
patients who underwent TV surgery with different techniques at the time
of TAC repair. However, the surgical techniques in this study are
mentioned but not explained in detail8. We describe a
detailed surgical technique which is reproducible in patients with a
quadricuspid TV. In these cases, usually one of the sinuses is
hypoplastic; we recommend the resection of the smallest sinus without
coronary ostium. With this approach a larger coaptation area of the
remaining sinuses can be achieved. To avoid postoperative obstruction of
the TV it is important to ensure that after resection the TV ring should
not be smaller than -1 Z Score. The limitation of this study is, that it
has been performed in a single patient and therefore requires
confirmation in a larger cohort of patients.