The Clover Technique For The Treatment Of Complex Tricuspid Valve Insufficiency

Objective: This study assesses the results of the ‘clover technique'(suturing together the middle point of the free edges of the tricuspid leaflets)for the treatment of tricuspid regurgitation(TR)due to severe prolapse or tethering.Methods: From March 2016 to December 2018,28 patients with severe TR due to prolapsing or tethered leaflets underwent ‘clover technique'.Annuloplasty was associated in 27 patients(97%).The aetiology of TR was rheumatic in 19 cases(68%),subacute bacterial endocarditis in four(14%),degenerative in three(11%)and ischemia of right ventricular(the peacing leads compress the septum leaflet in1 case)in two(7%).The main mechanism of TR was prolapse/flail of one leaflet in 7 patients(23%),of two leaflets in 13(46%)and of all three leaflets in 6(21%).The remaining two patients(7%)presented with severe leaflets' tethering.Results: None deaths(0%)occurred during hospitalisation and one patient discharged voluntary 12 days after surgery.Follow-up of the 27 hospital survivors was 100% complete(mean length 1.2 ±0.8years,range 3 months—1.7 years).At the last echocardiogram,no or mild TR was detected in 25(88.7%)patients,moderate (2+/4+)in two(9.6%)and severe(4+/4+)in one patient(3.6%).Mean tricuspid valve area and gradient were 4.3 ±0.6 cm2 and 2.8 ±1.4 mm Hg.In all patients,echocardiography was performed and no signs of tricuspid stenosis were detected.At the multivariable analysis,the degree of TR at hospital discharge was identified as the only predictor of TR 2+ at follow-up.Conclusions:This study showed that ‘clover procedure'was simple and safe in the surgical management of TR with leaflet injury,it is an effective supplementary measure for annuloplasty and valves.