Hybrid annuloplasty ring procedure for tricuspid valve replacement of Bjork Fontans.

BACKGROUND

Prosthetic 'tricuspid valve' placement in Bjork Fontan patients born with tricuspid atresia can transition these patients to a biventricular circulation.

OBJECTIVE

Describe intermediate term results of hybrid prosthetic valve placement in Bjork Fontans using annuloplasty ring placement around the Bjork connection followed by transcatheter valve.

METHODS

A retrospective review of hybrid attempts to valve large Bjork Fontans at UCLA. Only Bjorks that had failed balloon sizing for transcatheter valve placement or had prohibitively large dimensions on cross sectional imaging were included. All had attempted surgical placement of a non-circumferential annuloplasty ring around the Bjork Fontan and subsequent Sapien valve implant.

RESULTS

Median age of the five patients was 40-years. Three had successful placement of annuloplasty rings with a 30 mm (n = 2) or a 34 mm Edwards Physio Annuloplasty ring followed by successful valving with 29 Sapien 3 valves. In two patients, attempts to place a surgical ring resulted in bleeding requiring cardiopulmonary bypass and surgical valve placement. The median follow-up time was 28.7 months. All patients had a significant decrease in CVP and were alive with improvement in their NYHA class to I at most recent follow-up. There was no evidence of valve dysfunction seen on follow up ECHO or cross-sectional imaging.

CONCLUSION

Bjork Fontan patients often have connections too large for available balloon expandable valves. These patients can be treated with a hybrid incomplete annuloplasty ring placement to enable transcatheter valve placement.