Tricuspid Valve Repair—Indications and Techniques: Suture Annuloplasty and Band Annuloplasty

Abstract

n w l T t m p 3 g d Recently there has been new interest in the tricuspid valve, as different research identified late tricuspid regurgitation, often a consequence of uncorrected lesion during surgery, as a determinant of poor clinical outcome and even of higher late mortality.1,2 However, it is still not clear when, at the first operation, functional tricuspid regurgitation has to be corrected. In most of the surgical articles, the decision to perform tricuspid valve (TV) repair during mitral valve (MV) surgery was left to the surgeon’s discretion or even was not specified.2-5 The 2008 American Heart Association/American College of Cardiology guidelines6 suggested to perform TV annuloplasty in patients with severe tricuspid regurgitation (TR) requiring MV surgery for MV disease (class IB); TV annuloplasty for TR less than severe should be indicated in patients undergoing MV surgery having pulmonary hypertension or tricuspid annular dilation (class IIB). The European Society of Cardiology (ESC) guidelines7 suggested to perform TV annuloplasty in severe TR undergoing left-sided valve surgery (class IC) and in moderate TR with dilated annulus (maximum systolic tricuspid annulus, TA, 40 mm, 4-chamer view) in patients undergoing left-sided valve surgery (class IA, level C). A different surgical vision was presented by Dreyfus and oworkers,8 who suggested performing tricuspid annuloplasty regardless of the grade of trisupid regurgitation, when the tricuspid annular diameter was greater than twice the normal size ( 70 mm). The measurement of TA diameter (distance between the anteroseptal commissure and the anteroposterior commissure) was performed in the operative field, when the right atrium was vertically opened, using a simple ruler. Our group9 based the decision to perform TV nnuloplasty on the preoperative echocardiographic TA sysolic dimensions, as TR happens in systole. We found in a ohort of 20 volunteers a median systolic TA value of 24 mm ith a maximum of 28 mm; thus, we decided to perform TV nnuloplasty in all cases of moderate-to-more TR and in the ase of mild functional TR when systolic TA was higher than 4 mm. The results of our study demonstrated that patients