Ring, Band or Suture in Tricuspid Annuloplasty for Functional Tricuspid Regurgitation; Which is Better and More Durable?
Abstract
Background: In this study, we evaluate different annuloplasty modalities to repair functional tricuspid regurgitation.
Patients and methods: Between January 2011 and
January 2017, 200 patients with moderate or greater functional tricuspid regurgitation received tricuspid valve repair as part of primary surgeries on the left side of their cardiac valves. Of these, 39 patients received rings (Group A), 84 patients received bands (Group B), and 77 patients received suture annuloplasty (Group C).
Results: Two patients from Group C were operated on again, during the primary hospital stay due to severe symptomatic tricuspid regurgitation. The degrees of early postoperative tricuspid regurgitation – mean vena contracta and mean jet area – significantly were higher in Group C. During a mean follow-up period of 26 ± 12.6 months, 5 patients within Group C (6.85%) and one patient in Group B (1.3%) were operated on again with tricuspid valve replacement due to severe symptomatic tricuspid incompetence. Also during follow up, mean degrees of tricuspid regurgitation, mean vena contracta, and mean jet areas significantly were higher in Group C.
Conclusion: Patients who received rings followed by band annuloplasty had better early and late results with lower recurrence rates than those who received suture annuloplasty
References
Bernal JM, Gutierrez-Morlote J, Llorca J, et al. 2004. Tricuspid valve repair: an old disease, a modern experience. Ann Thorac Surg 78: 2069–74.
Bianchi G, Solinas M, Bevilacqua S, Glauber M. 2009. Which patient undergoing mitral valve surgery should also have the tricuspid repair? Interact Cardiovasc Thorac Surg 9:1009–20.
Calafiore AM, Di Mauro M. 2011. Tricuspid Valve Repair—Indications and Techniques: Suture Annuloplasty and Band Annuloplasty. Operative Techniques in Thoracic and Cardiovascular Surgery 16:86-96.
Chan KM, Zakkar M, Amirak E, Punjabi PP. 2009. Tricuspid valve disease: pathophysiology and optimal management. Prog Cardiovasc Dis 51:482–6.
Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. 2005. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg 79:127–32.
Gatti G, Maffei G, Lusa AM, Pugliese P. 2001. Tricuspid Valve Repair With the Cosgrove-Edwards Annuloplasty System: Early Clinical and Echocardiographic Results. Ann Thorac Surg 72:764 –7.
Guenther T, Mazzitelli D, Noebauer C, et al. 2013. Tricuspid valve repair: is ring annuloplasty superior? Eur J Cardiothorac Surg 43:58–65.
Matsunaga A, Duran CM. 2005. Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation. Circulation 112:I453–7.
McCarthy PM, Bhudia SK, Rajeswaran J, et al. 2004. Tricuspid valve repair: Durability and risk factors for failure. J Thorac Cardiovasc Surg 127:674–85.
Morishita A, Kitamura M, Noji S, et al. 2002. Long-term results after De Vega’s tricuspid annuloplasty. J Cardiovasc Surg (Torino) 43:773–7.
Naqshband MS, Abid AR, Akhtar RP, Waheed A, Khan JS. 2010. Functional tricuspid regurgitation in rheumatic heart disease: surgical options. Ann Thorac Cardiovasc Surg 16: 417–25.
Nath J, Foster E, Heidenreich PA. 2004. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 43:405–9.
Navia JL, Brozzi NA, Klein AL, et al. 2012. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg 93:59–69.
Navia JL, Nowicki ER, Blackstone EH, et al. 2010. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg 139:1473–82.
Parolari A, Barili F, Pilozzi A, Pacini D. 2014. Ring or Suture Annuloplasty for Tricuspid Regurgitation? A Meta-Analysis Review. Ann Thorac Surg 98:2255–63.
Rogers JH, Bolling SF. 2009. The tricuspid valve: Current perspective and evolving management of tricuspid regurgitation. Circ. 119:2718-25.15.
Tang GH, David TE, Singh SK, et al. 2006. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation 114:I577–81.
Van de Veire NR, Braun J, Delgado V, et al. 2011. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg 141:1431–9.
Wang G, Sun Z, Xia J, et al. 2008. Predictors of secondary tricuspid regurgitation after left-sided valve replacement. Surg Today 38:778–83.
Zhu TY, Wang JG, Meng X. 2013. Is a rigid tricuspid annuloplasty ring superior to a flexible band when correcting secondary tricuspid regurgitation? Interact Cardiovasc Thorac Surg 17:1009–14.
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