Rigid Ring Implantation versus Suture Annuloplasty for Secondary Tricuspid Regurgitation in the Time of Left Side Heart Valve Surgery: Single Center Long-term Follow-up

Murat N. Mukharyamov ¹, Roin Dzhordzhikia ², Rustem Khairullin ¹, Ildar Vagizov ¹, Artur Kaipov ¹

¹ MKDC, Kazan, Russia; ² Kazan State Medical University, Kazan, Russia;

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

The aim of the study is the evaluation of long term results of tricuspid valve repair for secondary insufficiency in the time of the left heart valve surgery (mitral or aortic or both). Methods. 643 consecutive patients operated between 2009-2016 were retrospectively enrolled in the study. The mean age was 56.9±10 years, 38% were males. Baseline preoperative echocardiographic characteristics were evaluated (ejection fraction, tricuspid annulus diameter, right ventricle dimensions, pulmonary pressure etc.) The whole cohort was divided on two groups: I – suture annuloplasty (De Vega procedure and its modifications) n-343, II – rigid ring implantation (30-36) n-280.  Freedom from the recurrent tricuspid regurgitation in the long term were assessed (Kaplan-Mayer analysis and log-rank Mantel-Cox test). Results. Baseline echocardiographic characteristics did not differ significantly between the groups I and II in terms of ejection fraction (54,1±8,6% and 55,2±7,9%), pulmonary artery pressure (56,9±19 mm.hg and 55,4±16 mm.hg), right ventricle (2,78±0,7 cm and 2,78±1,5 cm), tricuspid valve fibrous annulus (3,76±0,5 cm and 3,76±0,5 cm) Cross clamp time and cardiopulmonary bypass time did not differ significantly in both groups. Hospital mortality was 1,8% in rings group and 1% in suture repair group (р>0,05). Tricuspid regurgitation grade was significantly decreased immediately postoperatively in both groups from 2,6±0,6 to 1,02±0,7. Mild to moderate (2+) residual regurgitation were observed in 20% of patients of group I and 19% of group II. Long term freedom from recurrent regurgitation results (up to 5 years) revealed significant reduction (20% versus 54% - log-rank p=0,0066) of tricuspid regurgitation recurrence in rings group (II). Conclusions. Both suture and ring annuloplasty lead to satisfactory immediate hemodynamic result. However much more stable long term results in the rigid ring implantation group should be considered as a significant and determinative factor in choosing the way to repair the valve for secondary tricuspid regurgitation.