Suture Annuloplasty Research Articles

Непосредственные результаты шовной и имплантационной аннулопластики трикуспидального клапана при функциональной трикуспидальной недостаточности

Непосредственные результаты шовной и имплантационной аннулопластики трикуспидального клапана при функциональной трикуспидальной недостаточности

Clinical efficacy of two different tricuspid annuloplasty techniques in left cardiac valve surgery

Objective: To investigate the mid-and long-term clinical effects of tricuspid valvuloplasty with the implantation of an artificial plastic ring. Methods: Data of 677 patients who had functional tricuspid regurgitation and left cardiac valve disease and underwent tricuspid valvuloplasty and left cardiac valve surgery were retrospectively. Among these patients, 353 underwent simple suture annuloplasty (group A) while the rest 324 patients underwent artificial plastic ring annuloplasty (group B). The two-year and more-than-two-year clinical and ultrasonocardiograph (UCG) follow-up data of the two groups were obtained and compared. Results: A total of 600 patients (88.6%) completed the long-term follow-up (more than two years). The two-year follow-up showed no significant difference in the incidence of mild tricuspid regurgitation between the two groups (82.2% vs. 92.7%, P=0.37). However, there were significantly more cases that developed into moderate to severe tricuspid regurgitation in group A than in group B (17.8% vs. 7.3%, P=0.031). The long-term follow-up revealed that the recurrence rate of tricuspid regurgitation in group B was significantly lower than that in group A (11.0% vs. 25.0%, P=0.029), and the ratio of cases developing into moderate to severe tricuspid regurgitation in group A was significantly higher than that in group B (28.9% vs. 9.9%, P=0.007). The comparison between the two intra-group time segments showed that the development of tricuspid regurgitation in group A was significantly increased (28.9% vs. 17.8%, P=0.022), but in group B it was relatively stable (9.9% vs. 7.3%, P=0.52). Conclusions: Artificial ring annuloplasty is associated with significantly less tricuspid regurgitation than simple suture annuloplasty.

Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty

ObjectiveThe lack of annular stabilization is the drawback of aortic root remodeling, and recently the addition of annuloplasty has been proposed. Limited data, however, exist on late annular size after remodeling. We studied annular size over time. MethodsIn 241 patients (53 ± 16 years) annular size was determined preoperatively (T0), before discharge (T1), and at least 2 years after remodeling (T2, 54 ± 27 months) with (n = 52) or without external suture annuloplasty. Seventeen patients had Marfan syndrome (7%), 100 a bicuspid valve (41%), and 22 acute dissection (9%). Mean graft size was 25.2 ± 1.3 mm, and annuloplasty size 24.3 ± 1.4 mm. ResultsAnnular size was significantly reduced after repair and remained stable over time (T0: 27.4 ± 3.0 mm, T1: 24.2 ± 2.5 mm, T2: 24.2 ± 2.6 mm). After propensity-score matching (n = 33 each), baseline annular size was similar (with annuloplasty vs without: 28.7 ± 4.1 mm vs 27.8 ± 2.8 mm). Annular reduction was less effective without annuloplasty (23.9 ± 2.0 mm vs 25.6 ± 2.2 mm, P < .01); size was identical at follow-up (23.8 ± 2.2 mm vs 25.1 ± 2.5 mm, P = .03). After matching, freedom from annular size increase >10% at 4 years was 93 ± 5% without annuloplasty and 91 ± 9% with annuloplasty (P = .92). A linear mixed-effects model identified no significant effect of annuloplasty on annulus diameter change at T2 (P = .48). Era after 2004, Marfan syndrome, and smaller annulus diameter at discharge were the independent predictors for late annular expansion. ConclusionsAortic annulus rarely dilates over time after remodeling. In the case of annular dilatation, annuloplasty normalizes annular size and may prevent further dilatation by enhancing cusp coaptation. Even without annuloplasty, the aortic annulus becomes smaller compared with preoperative dimensions when aortic valve remains competent.

Valve-sparing aortic root replacement in patients with Marfan syndrome-the Homburg experience.

Aortic root dilatation occurs in most patients with Marfan syndrome with secondary valve failure or aortic complications being frequent consequences (1). The traditional surgical approach has been composite replacement of aortic valve and root, first described in the 1960s (2). Since the advent of valve-preserving aortic surgery, different techniques (3,4) have also been applied to Marfan patients. Generally they have resulted in good stability and a low incidence of complications (5-8). In some series, valve reimplantation has resulted in better valve stability at 15 years compared to root remodeling (5,7). This might be due to the fact that this technique—different from remodeling—addresses annular dilatation. In our own clinical experience, both forms of valve preserving root replacement have led to comparable results (8). As root remodeling has been shown to result in more physiological hemodynamics (9), we have become more liberal to use this approach with time. Beginning in 2004, intraoperative measurement of effective height (10) led to better recognition and more objective treatment of cusp prolapse. Starting 2009 a suture annuloplasty (11) was added to root remodeling in the presence of basal dilatation. In the present study, we examined the results now reaching 22 years of follow-up. The investigation was based on data collected prospectively and analyzed retrospectively, primary endpoints were freedom from reoperation and from AR≥II.

Tricuspid valve regurgitation : Indications and operative techniques

Functional tricuspid valve (TV) regurgitation secondary to left heart disease (e.g. mitral insufficiency and stenosis) is observed in 75% of the patients with TV regurgitation and is thus the most common etiology; therefore, the majority of patients who require TV surgery, undergo concomitant mitral and/or aortic valve surgery. Uncorrected moderate and severe TV regurgitation may persist or even worsen after mitral valve surgery, leading to progressive heart failure and death. Patients with moderate to severe TV regurgitation show a3-year survival rate of 40%. Surgery is indicated in patients with severe TV regurgitation undergoing left-sided valve surgery and in patients with severe isolated primary regurgitation without severe right ventricular (RV) dysfunction. For patients requiring mitral valve surgery, tricuspid valve annuloplasty should be considered even in the absence of significant regurgitation, when severe annular dilatation (≥40 mm or >21 mm/m2) is present. Functional TV regurgitation is primarily treated with valve reconstruction which carries alower perioperative risk than valve replacement. Valve replacement is rarely required. Tricuspid valve repair with ring annuloplasty is associated with better survival and alower reoperation rate than suture annuloplasty. Long-term results are not available. The severity of the heart insufficiency and comorbidities (e.g. renal failure and liver dysfunction) are the essential determinants of operative mortality and long-term survival. Tricuspid valve reoperations are rarely necessary and associated with aconsiderable mortality.

Mitral annuloplasty ring suture forces: Impact of surgeon, ring, and use conditions

ObjectiveThe study objective was to quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie down and constrain a mitral annuloplasty ring to a beating heart. MethodsPhysio (Edwards Lifesciences, Irvine, Calif) or Profile 3D (Medtronic, Dublin, Ireland) annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N = 23). Tie-down forces and cyclic contractile forces were recorded and analyzed at 10 suture positions and at 3 levels of increasing peak left ventricular pressure. ResultsAcross all conditions, tie-down force was 2.7 ± 1.4 N and cyclic contractile force was 2.0 ± 1.2 N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the 2 primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true sizing. This was driven almost exclusively by Physio cases and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile 3D forces were significantly more uniform around the annular circumference. A suture's tie-down force did not correlate to its eventual contractile force. ConclusionsMitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.

Suture Dehiscence in the Tricuspid Annulus: An Ex Vivo Analysis of Tissue Strength and Composition

Surgical repair of functional tricuspid regurgitation (FTR) is an increasingly common practice, but annuloplasty suture dehiscence remains a significant problem. Quantitative and mechanistic understanding of annular suture holding strength can support more effective techniques for tricuspid valve device anchoring. Suture holding strength of ovine tricuspid annuli (n= 15) was quantified exvivo by pullout testing at 12 positions around their circumference. Collagen density in additional annuli (n= 7) was quantified at positions above each commissure and midleaflet point by two-photon autofluorescence microscopy, enabling mechanistic assessment of its role in imparting suture holding strength to the tissue. Suture holding strength from pullout testing varied significantly by annular position, with a maximum of 10.0 ± 4.1 N at the septal leaflet (6 o'clock) and a minimum of 4.3 ± 1.3 N at the posterior leaflet (1 o'clock). Leaflet midpoints showed significantly higher annular tissue strength than commissures (7.2 ± 3.4 N versus 5.6 ± 2.1 N, respectively, p= 0.008). Collagen density, measured by a normalized mean pixel intensity, was significantly higher in the septal annulus than in the posterior-septal commissure, posterior annulus, and anterior-posterior commissure. Suture holding strength showed a strong linear correlation with collagen density (R2= 0.822, p= 0.013). The clinical predominance of suture dehiscence at the septal annulus, despite its greater exvivo holding strength, suggests either adverse suture placement techniques in this region or asymmetric tensile loading after implantation. This issue highlights the need to optimize implantation techniques and to carefully assess anchor security in existing and next-generation FTR corrective devices.

Posterior suture annuloplasty for functional tricuspid regurgitation

Functional tricuspid regurgitation (TR) is primarily caused by enlargement of the tricuspid annulus due to right ventricular dilation, frequently secondary to left sided valvular disease. Early techniques for the treatment of functional TR were introduced by Jerome Kay in 1965 and Norberto DeVega in 1972. Modified suture annuloplasty is a modification of DeVega's semicircular purse string technique, however, it is based on Kay's principle of obliteration of the posterior segment of the annulus only. While ring annuloplasty is the procedure of choice for severe functional TR, posterior suture annuloplasty is a technically simpler option for patients with moderate functional TR.

Long-term survival of two dogs after mitral valve plasty

Two small 9-year-old dogs received mitral valve plasty (MVP) for severe mitral regurgitation that could not be controlled via drug administration. MVP consisted of chordal reconstruction using expanded polytetrafluoroethylene (ePTFE) sutures and semicircular suture annuloplasty using polypropylene sutures. In both cases, the clinical signs dramatically improved after MVP, although postoperative echocardiography revealed slight residual mitral regurgitant flow. Both dogs survived for several years after MVP without any signs of cardiac distress; one dog survived for 9 years and 1 month, and the other dog survived for 7 years and 10 months. These findings highlight the durability of ePTFE sutures as artificial chordae and the excellence of semicircular suture annuloplasty in small dogs.

Long-term results (up to 14 years) of the clover technique for the treatment of complex tricuspid valve regurgitation.

To report the long-term results of the clover technique for the treatment of complex forms of tricuspid regurgitation (TR). Ninety-six consecutive patients (mean age 60 ± 16.4, left ventricular ejection fraction 58 ± 8.8%) with severe or moderately-severe TR due to important leaflets prolapse/flail (81 patients), tethering (13 patients) or mixed (2 patients) lesions underwent clover repair combined with annuloplasty. The aetiology of TR was degenerative in 74 cases (77.1%), post-traumatic in 9 (9.4%) and secondary to dilated cardiomyopathy in 13 (13.5%). All patients but 3 (96.8%) underwent ring (59 patients, 61.5%) or suture (34 patients, 35.4%) annuloplasty. Concomitant procedures (mainly mitral surgery) were performed in 82 patients (85.4%). Hospital mortality was 7.2%. At hospital discharge 92 (95.8%) patients had no or mild TR. Follow-up was 98% complete (median 9 years, interquartile range 5.1; 10.9). At 12 years the overall survival was 71.6 ± 7.22% and the cumulative incidence function of cardiac death with non-cardiac death as competing risk 16 ± 4.1% [95% confidence interval (95% CI) 9.5-25.7]. At 12 years the cumulative incidence function of TR ≥ 3+ and TR ≥ 2+ with death as competing risk were 1.2 ± 1.2% (95% CI 0.1-5.8) and 28 ± 7.7% (95% CI 14.3-43.5), respectively. Preoperative left ventricular ejection fraction (hazard ratio 0.9, CI 0.9-1, P = 0.05) and previous cardiac surgery (hazard ratio 2.7, 95% CI 1-7.1, P = 0.03) were predictors of recurrent TR ≥ 2+ at univariable but not at multivariable analysis. Complex forms of TR due to severe prolapse or tethering of the leaflets can be effectively treated with the clover technique with very satisfactory long-term results and extremely low recurrence of severe TR.

A 6-YEAR EXPERIENCE OF HEART TRANSPLANTATION IN FEDERAL ALMAZOV NORTH-WEST MEDICAL RESEARCH CENTRE

Aim. To estimate the results of 6-year experience of heart transplantation (HT) in Federal Almazov North-West Medical Research Centre. Methods. From 2010 to 2015 we have performed 65 HT. Mean age was 44.3 ± 14 years old (from 10 to 64 years old). We used biventricular assist device (BIVAD, Berlin Heart Excor) support in 7 heart transplant candidates before HT. 19 patients (29%) received thymoglobulin, whereas 46 patients (71%) had basiliximab to induce immunosuppression.Results.Extracorporeal membrane oxygenation machines were implanted in 5 patients (7.7%) after HT due to acute right ventricular failure. Suture annuloplasty (the Batista procedure) for tricuspid valve repair was carried out in 3 cases (4.6%). Venovenous hemodiafi ltration was used in 11 patients (16.9%). A total of 598 endomyocardial biopsies (EMB) were performed after HT. Evidence of cellular rejection (R1 and R2) was presented in 286 biopsies (48%). The 30-day in-hospital mortality rate was 3.1%. The 6-month survival rate after HT was 92%, 1-year – 91% and overall survival for the 6-year period of observation – 89.2%. Maximum observation period was 71 months.Conclusions.The 6-year experience of HT in our Center has shown a high level of survival. BIVAD Excor support can be effectively used as a «bridge» to HT. Prevention of graft loss due to acute rejection in heart transplant recipients can be achieved only through regular EMB monitoring. The rate of viral infection increased in 2 months after HT.

Two decades of experience with root remodeling and valve repair for bicuspid aortic valves

ObjectiveBicuspid aortic valve anatomy is associated with ascending aortic aneurysm in approximately 50% of individuals and may lead to severe aortic regurgitation with aortic dilatation. Both entities may be treated by valve repair and root remodeling. The objective was to review the cumulative experience of 20 years. MethodsBetween November 1995 and December 2015, 357 patients (324 male; age 10-80 years; mean, 49 ± 13 years) underwent combined bicuspid aortic valve repair and root remodeling. Aortic regurgitation was relevant in 265 cases; the main indications for surgery were aortic regurgitation (n = 241), aortic aneurysm (n = 102), and acute dissection (n = 9). In 225 instances, a suture annuloplasty was added. Cusp calcification was present beyond the raphe in 52 cases, and an autologous pericardial patch was implanted for partial cusp replacement in 39 cases. All patients were followed. Follow-up was 97.8% complete with a mean of 57 ± 51 months (median, 39 months). ResultsTwo patients died (hospital mortality 0.6%), and survival at 15 years was 81%. Reoperation became necessary for recurrent aortic regurgitation in 24 patients; 6 patients underwent reoperation for stenosis. Cumulative incidence of reoperation at 15 years was 21.7%. Cusp calcification and the use of a pericardial patch for cusp reconstruction were associated with time to reoperation (P = .002). ConclusionsRepair of the bicuspid aortic valve combined with root remodeling leads to excellent 10- and 15-year results. Cusp calcification and the need for partial cusp replacement are associated with valve failure.

Long-Term Outcomes of Suture vs. Ring Tricuspid Annuloplasty for Functional Tricuspid Regurgitation.

Whether there is a significant difference in the long-term surgical outcomes between suture annuloplasty and ring annuloplasty for the treatment of functional tricuspid regurgitation (TR) is still controversial. We compared the long-term outcomes of tricuspid annuloplasty (TAP) with and without an annuloplasty ring.Methods and Results:From January 1996 to December 2015, we consecutively enrolled 684 patients (mean age, 65.5 years; 60% women) undergoing TAP for functional TR: 312 underwent conventional suture annuloplasty (Group S) and 372 underwent ring annuloplasty (Group R). Baseline characteristics were comparable between the 2 groups, except for age and the prevalence of prior cardiac surgery. The mean follow-up period was 7.3 years (range, 0.3-20.3 years).There was no significant difference in overall survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from recurrent moderate to severe TR between Groups S and R, although postoperative mean TR grade and sPAP were significantly lower in Group R. Multivariate analysis revealed that age, prior cardiac surgery, and preoperative severe TR were independent predictors of recurrent moderate or greater TR. There was no significant difference in the long-term surgical outcomes between ring and suture TAP, although postoperative mean TR grade was lower in the ring annuloplasty group.

Invited Commentary

Invited Commentary

Suture Annuloplasty Significantly Improves the Durability of Bicuspid Aortic Valve Repair

Isolated repair of the regurgitant bicuspid aortic valve (BAV) has yielded suboptimal durability, with annular dilatation being important risk factor for recurrent aortic regurgitation. We hypothesized that adding a suture annuloplasty (SA) should lead to improved repair stability. Between July 1999 and September 2014, 268 patients (mean age, 41 ± 13 years, 249 male) underwent isolated BAV repair. From January 2009 to September 2014, 164 consecutive patients (study group) underwent SA using either braided polyester (n= 37) or expanded polytetrafluorethylene (PTFE) (n= 127). Patients who underwent surgery prior to January 2009 served as controls (n= 104). All patients were followed (98.9% complete, 1 week to 181 months). Annular size was larger in the study group (p< 0.001) and age was lower (p < 0.001). There were no differences between the groups regarding other clinical data. Hospital mortality was 0.7% (n= 2), 10-year survival was 94.2%. Thirty-six patients required valve-related reoperations (8 days to 94 months postoperatively; controls= 32, study= 4). Complications related to SA (ventricular septal defect, interference with coronary artery) occurred in 6 (3.7%) patients, in 4 (10.8%) patients with polyester SA and in 2 (1.6%) patients with PTFE. In the control group freedom from reoperation at 5and 10 years was 73.2% and 63.7%, respectively. With SA, 5-year stability was significantly improved to 92.6% (p=0.0006); it was 96.7% for PTFE versus 83.5% for polyester SA (p= 0.0132). Annular dilatation is a risk factor for failure after repair of regurgitant BAV. Its elimination through the use of SA significantly improves repair stability. With PTFE as material for SA optimal repair stability and minimal local complications are achieved.

Non-ischaemic mitral valve suture annuloplasty: late follow-up results.

To evaluate late outcomes after posterior mitral valve (MV) annulus double-suture annuloplasty for degenerative (non-ischaemic) MV insufficiency. Between 2005 and 2011, 138 patients underwent MV repair using posterior MV double-suture annuloplasty and an additional 105 patients underwent tricuspid valve repair. The study protocol included operative mortality, reoperation rate and reasons, as well as echocardiographic parameters at pre- and postoperative and follow-up periods (2-9 years). In-hospital mortality was 2/138 (1.45%). Early post operation, no regurgitation was noted in 74/136 (54.4%) patients, I(o) regurgitation was observed in 55/136 (40.4%), II(o) was observed in 6/136 (4.4%) and III(o) was observed in 1/136 (0.7%); during late follow-up (from 2 to 9 years), no regurgitation was observed in 21.6% patients, I(o) was observed in 58%, II(o) was observed in 17% and III(o) was observed in 3.4%. The mean preoperative anterolateral diameter of the MV annulus was 39.02±4.97 mm and, at late follow-up, it was 27.66±3.94 mm (p=0.000); at these same time points, left ventricular end-diastolic diameter (LVEDD) was 55.74±7.29 mm and 49.17±6.01 mm (p=0.000), respectively, and the left ventricular ejection fraction (LVEF) was 53.08±8.93% and 50.92±6.78%, respectively (p=0.007). This study demonstrates suture annuloplasty to be an effective treatment up to 9 years for degenerative mitral valve disease. This technique enables preservation of the posterior mitral valve annulus diameter with stable long-term (up to 9 years) reduction, a competent (no regurgitation/⩽II(o) regurgitation) MV in 96.6% of cases and positive left ventricular (LV) remodelling.

Retrospective Study to Compare Ring Annuloplasty and Suture Annuloplasty in Tricuspid Valve Diseases

The Tricuspid regurgitation may be primary or secondary to left sided heart disease Residual tricuspid regurgitation is seen after tricuspid valve annuloplasty(TVA) - both ring and suture anuloplasty. A study was conducted in KEM Hospital as to validate the benefits of ring annuloplasty over suture anoloplasty. 80 patients undergoing MVR and TVA were studied. Of these 50 patients underwent MVR with ring annuloplasty and 30 underwent MVR with DeVegas annuloplasty. 2DECHO was done pre and postoperatively to determine pulmonary artery systolic pressure(PASP), grade of tricuspid regurgitation (TR), LV ejection fraction(LVEF) and tricuspid annulus. 82% of patients of ring annuloplasty group had reduction in PASP postoperatively compared to 56% in DeVegas annuloplasty . Grade of TR improved from moderately severe TR to mild TR in 86% in the ring annuloplasty group compared to53% in DeVegas annuloplasty group. 58% of patients of ring annuloplasty had maintained LV function postoperatively compared to 46% of patients in DeVegas annuloplasty.The mean tricuspid annulus showed reduction from preoperative annulus size of 37.72 to 27.5 in ring annuloplasty group and from 37.9to 27.13 in DeVegas annuloplasty group. Tricuspid ring annuloplasty is a better and durable repaire compared to suture annuloplasty for secondary TR. Aggressive management of secondary TR such as this could hopefully decreas the occurence of late TR following previous left sided valve surgery

Tricuspid valve repair for severe tricuspid regurgitation due to pacemaker leads.

Tricuspid valve regurgitation due to pacemaker leads is a well-known complication. Although some reports have suggested that pacemaker leads should be surgically explanted, strongly adhered leads cannot always be removed. The aim of this study was to describe our tricuspid valve repair techniques with pacemaker leads left in situ. Our retrospective study investigated 6 consecutive patients who required tricuspid valve surgery for severe regurgitation induced by pacemaker leads. From the operative findings, we identified 3 patterns of tricuspid valve and pacemaker lead involvement. In 3 patients, the leads were caught in the chordae, in 2 patients, tricuspid regurgitation was caused by lead impingement on the septal leaflet, and in 3 patients, tricuspid valve leaflets had been perforated by the pacemaker leads. During surgery, all leads were left in situ after being separated from the leaflet or valvular apparatus. In addition, suture annuloplasty was performed for annular dilatation in all cases. In one patient, the lead was reaffixed to the annulus after the posterior leaflet was cut back towards the annulus, and the leaflet was then closed. There was one hospital death due to sepsis. The degree of tricuspid regurgitation was trivial in all surviving patients at discharge. During a mean follow-up of 21 months, one patient died from pneumonia 20 months after tricuspid valve repair. In patients undergoing tricuspid valve surgery due to severe tricuspid regurgitation caused by pacemaker leads, the leads can be left in situ after proper repair with annuloplasty.

Surgical repair of tricuspid regurgitation due to annular detachment caused by chest trauma

Traumatic tricuspid valve regurgitation (TR) is a fairly rare complication of blunt chest trauma, and is usually caused by chordal and/or papillary muscle rupture. A 45-year-old woman, with a history of blunt chest trauma 16 years previously, was referred for surgery due to severe TR. During surgery, we found a large perforation on the right atrial wall located just anteriorly to the anterior leaflet, which was caused by annular detachment, in addition to anterior leaflet prolapse due to rupture of anterior chordae. The tricuspid valve was successfully repaired by direct closure of the perforation and chordal replacement with suture annuloplasty. Herein, we report a successful surgical repair of TR with annular detachment with right atrial dissection caused by blunt chest trauma.<Learning objective: Traumatic tricuspid valve regurgitation is rare, but one may encounter it from time to time. In this report, we describe the first case report of tricuspid annular detachment with fistula between the right atrium and the right ventricle caused by right atrial dissection, in which successful surgical repair was performed.>

Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery

ObjectiveThere is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair. MethodsWe reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. ResultsIn the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95% confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857). ConclusionsLate survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.