Abstract
BackgroundTo evaluate early and midterm outcomes of tricuspid ring annuloplasty using three-dimensional (3D) MC3 ring for treatment of functional tricuspid regurgitation (FTR) during mitral valve replacement for rheumatic valve disease.ResultsThis prospective study included 105 patients who underwent repair for ≥ moderate tricuspid regurgitation (TR) during mitral valve replacement for rheumatic valve disease. Between January 2016 and December 2018, a group of 23 patients who underwent ring annuloplasty with Edward MC3 rings was compared to another group of 82 patients who underwent standard suture (DeVega) repair. The primary outcome was residual TR (≥ moderate TR). During an average follow-up period of 18.84 ± 9.90 months (range 3–33 months), the preoperative grade of TR improved significantly in both groups. The postoperative mean of TR in the MC3 group was significantly lower than that in the DeVega group (0.17 ± 0.49 versus 0.77 ± 0.93, P = 0.004). The rate of TR recurrence (≥ 2+ TR) was significantly higher after MC3 ring annuloplasty (4.3% versus 23.1%, P = 0.03). Freedom from mild TR was 30.5% in the DeVega group and 61% in the ring annuloplasty group (P = 0.007). Freedom from residual TR was 76.8% in the DeVega group and 95.7% in the ring annuloplasty group (P = 0.04).ConclusionsThe use of MC3 rings is a safe and effective alternative to DeVega repair for the management of FTR. However, further evaluation of long-term durability is recommended.
Highlights
To evaluate early and midterm outcomes of tricuspid ring annuloplasty using three-dimensional (3D) MC3 ring for treatment of functional tricuspid regurgitation (FTR) during mitral valve replacement for rheumatic valve disease
There was no significant difference in the preoperative echocardiographic parameters between both groups of tricuspid annuloplasty regarding the grade of TR, systolic pulmonary artery pressure (SPAP), tricuspid annulus (TA) diameter, tricuspid annular plane systolic excursion (TAPSE), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), and left ventricular ejection fraction (LVEF) (Table 1)
Regarding comparisons of postoperative and baseline preoperative echocardiographic measurements in each group, there was a significant decrease in the mean of TR grade, SPAP, TA diameter, LAD, and LVESD in both groups, with a significant increase in the mean of LVEDD and LVEF
Summary
To evaluate early and midterm outcomes of tricuspid ring annuloplasty using three-dimensional (3D) MC3 ring for treatment of functional tricuspid regurgitation (FTR) during mitral valve replacement for rheumatic valve disease. Functional tricuspid regurgitation (FTR) is a common consequence with mitral valve disease (rheumatic, ischemic, degenerative, or dilated cardiomyopathy), secondary to dilation or dysfunction of the right ventricle, tricuspid annular dilatation, leaflet tethering, atrial fibrillation (AF), or pulmonary hypertension [1]. The surgical techniques for FTR vary from suture repair to implantation of prosthetic rings. Since the first introduction of prosthetic rings for tricuspid annuloplasty in 1971, multiple ring designs have been developed to reinforce the tricuspid annulus by fixing the annulus during systole, restoring the physiologic valve geometry, reducing the annular dilatation, or restoring the 3D morphology [4]. The prosthetic rings for tricuspid annuloplasty have been categorized in
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