Undersized Tricuspid Annuloplasty Rings Optimally Treat Functional Tricuspid Regurgitation

• Published in: The Annals of thoracic surgery Vol. 92; no. 1; pp. 89 - 96
• Main Authors: Ghoreishi, Mehrdad, MD, Brown, Jamie M., MD, Stauffer, Craig E., BS, Young, Cindi A, Byron, Mary J., PA-C, Griffith, Bartley P., MD, Gammie, James S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2011; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Valve Annuloplasty - adverse effects; Cardiac Valve Annuloplasty - methods; Cardiac Valve Annuloplasty - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Cohort Studies; Echocardiography, Doppler - methods; Echocardiography, Transesophageal - methods; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Valve Prosthesis; Hospital Mortality - trends; Humans; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Complications - diagnostic imaging; Postoperative Complications - surgery; Prosthesis Design; Recurrence; Reoperation - methods; Retrospective Studies; Risk Assessment; Surgery; Survival Analysis; Time Factors; Treatment Outcome; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - surgery; 35; Treatment; Cardiac valvular disease; Ring; Cardiovascular disease; Anesthesia; Circulatory system; Annuloplasty; Cardiology; Tricuspid regurgitation; Tricuspid valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.03.024

Background In contrast to mitral valve repair, residual and recurrent regurgitation after tricuspid valve (TV) repair for functional tricuspid regurgitation (TR) is common. We have systematically used undersized, rigid 3-dimensional annuloplasty rings to treat functional TR. Methods From March 2006 to October 2009, 101 consecutive patients with moderate or greater functional TR underwent TV repair with an undersized rigid 3-dimensional annuloplasty ring. All patients had a predischarge echocardiography evaluation in a core echocardiography laboratory. Follow-up echocardiography was available for 96% of surviving patients. Mean follow-up was 17 ± 9 months. Results Twenty-nine percent of patients had undergone previous cardiac operations, 74% were in New York Heart Association functional class III or IV, and 48% had atrial fibrillation. Mitral valve operations were performed in 93 patients, aortic valve operations in 17, coronary artery bypass grafting in 21, and CryoMaze procedures in 40. Size 26 or 28 rigid tricuspid annuloplasty rings were used in 88% of patients, and no ring larger than a 28 has been used since November 2008. The operative mortality rate was 6% (n = 6). Freedom from significant TR (TR > moderate) at hospital discharge, as assessed by the clinical core laboratory, was 97%. Only 3% of patients had TR greater than moderate during follow-up. No patient required TV reoperation. New postoperative permanent pacemakers were inserted in 3 patients. Conclusions Tricuspid valve repair with an undersized (size 26 or 28) rigid 3-dimensional annuloplasty ring is the method of choice for reliable and durable treatment of functional TR.