Beating heart tricuspid valve replacement without snugging vena cavae

Abstract

Tricuspid valve replacement (TVR) is traditionally performed after giving cardioplegia and arresting the heart, but sometimes dense adhesions in redo cases can render looping superior and inferior vena cavae almost impossible. We had a case where the right atrium was hugely dilated and stuck and adhesions were dense, and the condition of the patient was too sick to tolerate myocardial ischemia. We did TVR on a beating heart with femoral and innominate vein cannulation without snugging vena cavae and carefully maintaining a blood level in the right atrium just below tricuspid valve and above the vena caval opening so as to avoid an air lock. It is an innovative technique in a difficult scenario.

Keywords

• Beating heart
• off-pump
• tricuspid valve replacement