Introduction
Functional tricuspid regurgitation (FTR) is usually due to left heart disease or intrinsic lung disease, both resulting in pulmonary hypertension and right ventricle failure (RVF). Untreated FTR leads to increased morbidity and mortality. However, indications for surgical treatment are vague, leading to a recurrence rate of 30-45%. The complex tricuspid valve (TV) geometry and dynamics, and its
implications for surgery, remain to be investigated. To improve outcomes of surgical and percutaneous TV repair, an increased understanding of TV-RV biomechanics during RVF is mandatory.
Methodology
Investigating TV-RV biomechanics is based on simultaneously measuring systolic-diastolic displacement of the TV using sonomicrometry, and RV pressure-volume loops via the conductance method, in an adult porcine model of pressure-overload RVF. Firstly, TV-RV dynamics in normal hearts will be compared with RVF. Then the effect of TV annuloplasty on TV-RV dynamics will be investigated, comparing anatomically sized and undersized rings. Thirdly, the effect of TV leaflet
augmentation will be quantified.
Results
Firstly, we will quantitatively determine the stress distribution at the TV components, in relation to RV P-V loops during RVF. Subsequently, we aim to assess the effect of undersized TV annuloplasty on TV-RV dynamics. Lastly, we will investigate whether the TV stress distribution can be improved by surgical alteration of TV geometry using leaflet augmentation techniques.