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Original Articles: Adult Cardiac

Undersized Tricuspid Annuloplasty Rings Optimally Treat Functional Tricuspid Regurgitation

Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland

Accepted for publication March 9, 2011.

^_* Address correspondence to Dr Gammie, Division of Cardiac Surgery, University of Maryland Medical Center, N4W94, 22 S Greene St, Baltimore, MD 21201 (Email: jgammie{at}smail.umaryland.edu).

Presented at the Fifty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 3–6, 2010.

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.

This article has been cited by other articles:

				B. Mahesh, F. Wells, S. Nashef, and S. Nair Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery Eur J Cardiothorac Surg, January 1, 2013; 43(1): 2 - 8. [Abstract] [Full Text] [PDF]

				M. Khorsandi, A. Banerjee, H. Singh, and A. R. Srivastava Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation? Interact CardioVasc Thorac Surg, July 1, 2012; 15(1): 129 - 135. [Abstract] [Full Text] [PDF]