Long-term Outcomes of Tricuspid Valve Repair: The Influence of the Annuloplasty Prosthesis

Abstract

The ideal tricuspid valve annuloplasty (TVA) prosthesis is controversial. This study aimed to compare the effect of rigid versus flexible TVA prostheses on long-term outcomes after repair of functional tricuspid regurgitation (FTR). We included 713 patients who had repair of FTR from 2009 to 2017. Patients were divided into 2 groups according to the type of TVA prosthesis. Group 1 (n= 104) included patients who had repair using rigid rings; group 2 (n= 609) included patients with flexible bands. Median age was 53.5 years (25th through 75th percentiles; range, 42.5-62 years) in group 1 versus 56 years (range, 45-65 years) in group 2 (P= .11). Propensity score matching identified 91 matched pairs for comparison. In the matched pairs, operative mortality was identical (4 in both groups [4.4%]; P ˃ .99). Median follow-up was 55 months (range, 28-83 months). The cumulative incidence of moderate or higher tricuspid regurgitation (TR) in the presence of death as a competing risk was higher in group 2 (subdistribution hazard ratio= 1.63, P= .019; and subdistribution hazard ratio= 1.6, P= .099 before and after matching, respectively). There was a trend of higher pacemaker insertion in group 1 (7 [7.69%] versus 3 [3.3%]; P= .34), which did not reach statistical significance after matching. There was no significant change in the degree of TR over time between groups (odds ratio= 1.21, P= .53; and odds ratio= 1.75, P= .21 before and after matching, respectively). Both types of TVA prostheses had comparable efficacy in managing FTR; however, freedom from moderate or more TR was higher in the rigid ring group.