Surgical techniques in patients with functional tricuspid valve insufficiency: experience with two reconstructive techniques

Abstract

BACKGROUND: Only few reports have dealt with the issue of long-term efficacy of different annuloplasty techniques in patients with functional tricuspid valve insufficiency and its impact on outcome parameters. The goal of this retrospective study was to compare two widely used reconstructive techniques: prosthetic ring annuloplasty (PRA) and suture annuloplasty (SA). METHODS: The study included 194 patients, who underwent repair of functional tricuspid insufficiency > Grade II+ between 1984 and 2003. 144 patients received a PRA and 50 patients received a SA (median follow-up in both groups: 7.5 years). 30% of all patients had already undergone prior cardiac operations. RESULTS: At the latest follow-up, the occurrence of recurrent tricuspid insufficiency of at least Grade II+ (36% vs. 4.6%) and the occurrence of reoperation for recurrent tricuspid insufficiency (20% vs. 0%) were all substantially higher in the SA- than in the PRA-group. In addition, survival throughout the follow-up period was lower in patients receiving a SA (75% and 32% at 1 and 10 years) as compared to those receiving a PRA (82% and 66% at 1 and 10 years, p < 0.01). Significant risk factors for mortality throughout the follow-up period included absence of ring annuloplasty, left ventricular dysfunction and higher Euroscore. CONCLUSIONS: The results of this retrospective study demonstrate that in patients with functional tricuspid insufficiency, PRA is superior to SA with regard to survival, recurrence of tricuspid insufficiency and incidence of reoperation. It is therefore recommended as the method of choice in patients with functional tricuspid insufficiency.