Early Clinical Outcomes of Tricuspid Ring Annuloplasty Using the New Three-dimensional Annuloplasty Ring, Tri-Ad

Abstract

We evaluated the early clinical outcomes of tricuspid ring annuloplasty using the Tri-Ad ring and compared the results of the Tri-Ad ring with those of MC3 ring, a widely used three-dimensional (3D) ring. From 2007 to 2017, 227 patients underwent tricuspid ring annuloplasty (TAP) for functional tricuspid regurgitation using the new 3D ring, Tri-Ad. In total, 191 patients underwent TAP with a MC3 ring and 36 patients underwent TAP with a Tri-Ad ring. Tri-Ad rings have been used since January 2015. Propensity score-matched analysis was performed (n = 36 in each group). Mean ± SD duration of follow-up was 67 ± 37 months. Operative mortality occurred in nine patients and postoperative complications in 39, which included atrial fibrillation (n = 9), low cardiac output syndrome (n = 15), and bleeding requiring reoperation (n = 15). There were no significant differences in operative mortality and postoperative complications (p = .650 and p = .423, respectively). In the Tri-Ad group, both tricuspid regurgitation grade and systolic pulmonary artery pressure significantly decreased compared with its preoperative values in predischarge echocardiography (from 2.00 ± 1.19 mmHg to 1.17 ± 0.81 mmHg [p < .001] and from 43.11 ± 13.21 mmHg to 38.58 ± 8.61 mmHg [p < .001], respectively). There were no ring-related complications, such as atrioventricular block or ring dehiscence during follow-up in Tri-Ad group. In matched patients, there were no significant differences in in-hospital mortality, postoperative complications, or tricuspid valve-related events (p = .310, p = .502, and p = .1.00, respectively). The Tri-Ad ring, a new 3D ring, showed comparable early clinical outcomes and echocardiographic results to the MC3 ring. However, a long-term follow-up study is required to confirm the safety and efficacy of this new device.