Tricuspid three-dimensional ring versus fashioned flexible band annuloplasty in management of functional tricuspid valve regurge: comparative long term study

Abstract

Background: Functional tricuspid valve regurgitation due to left sided valve lesions remains a common finding. Nowadays, different types of three-dimensional rings and flexible bands are considered to be the gold standard techniques for repair of such functional regurgitation. Our study aimed for long-term comparison of the durability and effectiveness of those techniques. Results: The data of 170 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid 3D rings (contour 3D or MC3 ring) or prosthetic fashioned bands (Dacron or PTFE) and mitral valve surgery between March 2013 and September 2018 were collected and analysed. Patients were classified in two matched groups: ring group (group A) consisting of 90 cases and band group (group B) consisting of 80 cases. follow-up period ranged from 55.2 to 78 months (mean 67.2 ± 10.8), during this period New York heart association for dyspnea functional class evaluation and full echocardiographic assessment were done and was scheduled as following: before hospital discharge, after 6 months of surgery and finally, every 2 years. In-hospital mortality was 1(1.1%) and 2 (2.5%) with p value 0.49 after ring or band annuloplasty, respectively. No significant differences in both groups regarding hospital mortality and morbidities. There was statistically significant decrease in NYHA class, degree of TR, and PASP within the 2 groups postoperatively with p value of 0.03, 0.04, and 0.033, respectively, with no statistically significant difference between both groups (p value > 0.05). There was statistically significant difference in the freedom from recurrent TR and need for reoperation during the follow-up period between both groups with lower recurrence and reoperation rates in group A, (p value 0.03 and 0.001, respectively). Conclusion: Tricuspid valve repair with different annuloplasty rigid three dimensional rings or fashioned flexible bands for functional tricuspid regurgitation offers good long-term outcome. Yet, the rigid rings maintain their benefits on the rate of recurrent TR and the need for reoperation.

Autologous Pericardial Band for Tricuspid Valve Annuloplasty: Midterm Results

“…In accordance, the conservative management of TR has been linked to patients' poor survival and unfavorable long-term consequences. According to current standards, surgery should be performed as soon as signs of RV dysfunction appear [16].…”

Mecanismos Fisiopatológicos, Avaliação Clínica E Estratégias De Manejo Da Regurgitação Tricúspide

“…Os anéis ou faixas de angioplastia são abertos na área do anel septal para evitar lesões no nó atrioventricular e sistema de condução de His. Anéis tricúspides que se assemelham à configuração tridimensional complexa do anel tricúspide nativo foram desenvolvidos e são usados para anuloplastia tricúspide 86 . Normalmente, a anuloplastia em anel do VT é preferível à anuloplastia com sutura direta devido à aumento da incidência de RT residual ou recorrente e necessidade de reoperação e aumento da sobrevida do paciente 87 .…”

Impact of tricuspid annuloplasty device shape and size on valve mechanics—a computational study

“… 6 Today, surgeons can choose from a range of devices that come in different shapes and sizes. 7 Although manufacturers provide guidelines for choosing device type (ie, shape) and size, device selection is often driven by surgeon experience and preference. For example, one documented strategy is to choose the device size identically to the device size chosen for the concomitant mitral valve repair.…”