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Ann Thorac Surg 2004;78:2074-2075
© 2004 The Society of Thoracic Surgeons
Department of Surgery, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec H1T 1C8, Canada
In this report by Bernal and colleagues, 1,232 patients underwent tricuspid valve (TV) repair using DeVega's technique or a segmental modification without a prosthetic ring. Follow-up averaged 6.8 years. Nine patients needed reoperation for TV dysfunction: 1 in the DeVega group and 8 in the modification group. In the author's opinion, repair without a prosthetic ring remains the procedure of choice. This point has been challenged by McCarthy and colleagues [1]. In a study of 790 patients, the McCarthy group reports a high recurrence rate with the DeVega technique as compared with using the Carpentier-Edwards ring. They recommend discarding repairs without a ring.
Late survival depends on several factors other than the durability of the repair. In our own analysis [2] using echocardiography, we found no difference in the need for rerepair or replacement and the incidence of right heart failure during the follow-up of 463 patients who underwent TV repair using either the DeVega technique, the Bex flexible band, or the Carpentier-Edwards ring. Nevertheless, we favor a partial or complete ring to support the tricuspid annulus and to ensure a smaller, stable annulus in the long term.
Three decades ago, Deloche and colleagues [3] established that in functional TV insufficiency dilatation occurred at the base of the anterior and posterior leaflets. A little later, Grondin and associates [4] envisioned the "end of the tricuspid challenge" with Carpentier's ring or DeVega's annuloplasty. More recently, Duran and colleagues [5] favored repair in all patients who present with moderate to severe tricuspid insufficiency at the time of operation.
A quarter of century later, we should say "yea" to Carpentier and to DeVega for solving the issue, but "nay, we don't know yet" as to which technique provides the best long-term results. We agree, however, with Duran and the current authors that all moderate and severe tricuspid insufficiency should be corrected at the initial valve operation.
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