Cosgrove Ring Annuloplasty For Functional Tricuspid Regurgitation

Abstract

Although tricuspid valve regurgitation can be caused by organic disease, most tricuspid regurgitation encountered in clinical practice is functional, occurring in patients with chronic left-sided valvular lesions. Ten percent to 50% of patients with severe mitral dysfunction have important tricuspid regurgitation. ~,2 In such cases, the tricuspid valve leaks during systole despite structurally normal leaflets and chordae. 3 Functional tricuspid regurgitation is attributable to the interaction of multiple factors, including annular and right ventricular dilation, pulmonary hypertension, and depressed annular shortening ~during systole. 3-z Recently, surgeons have taken a more aggressive approach to the treatment of tricuspid regurgitation in patients with left-sided valvular lesions. 3 When operating for ntitral or aortic valve disease, the surgeon should not ignore tricuspid regurgitation that is 3 + or 4+. Because tricuspid regurgitation is dynamic and is frequently down-graded by intraoperative echocardiography, the decision to address the tricuspid valve should be based on preoperative studies. Management of 2 § tricuspid regurgitation is controversial. Several surgical options have been employed in the treatment of functional tricuspid regurgitation. These include tricuspid valve replacement, bicuspidalization annuloplasty, suture annuloplasty, and partial or complete ring annuloplasty. There is general agreement that some sort of formal ring or band provides the best results, particularly in patients with puhnonary hypertension. 6-8 For correction of functional tricuspid regurgitation, we favor placement of a universally flexible band that reduces annular diameter adjacent to the anterior and posterior leaflets. Because five sixths of annular dilation takes place at the base of the anterior and posterior leaflets, positioning the band in this region directly addresses one of the most important derangements in patients with functional tricuspid regurgitation. 6,9 To ensure leaflet coaptation, a 26- or 28-mm annuloplasty device is used.