Tricuspid valve repair with Dacron band versus DeVega or segmental annuloplasty. Hospital outcome and short term results

Abstract

BackgroundThe purpose of this study was to compare the hospital outcome and short term results of tricuspid valve (TV) repair with three repair techniques for functional tricuspid regurgitation (TR), namely, flexible Dacron band, DeVega and segmental annuloplasty.MethodsA total of 60 patients underwent TV repair at National Heart Institute from January 2013 to November 2014, of which 20 had DeVega procedure (DV), 20 had a segmental annuloplasty (SA) procedure and 20 had a Dacron band (DB) procedure. Concomitant procedures done for rheumatic left sided valve pathology consisted of mitral valve replacement in 70% of patients, and double valve replacement in 30% of patients. Clinical and echocardiographic follow-up data were obtained. Follow-up was 100% complete and was concluded after one year.ResultsAll demographic criteria and preoperative characteristics of the three studied groups were comparable except for preoperative right ventricular (RVEDD) size that was significantly bigger in Dacron band group as compared to the other two groups (3.18 ± 0.43 cm compared to 3.00 ± 0.33 cm (DV) and to 2.88 ± 0.35 cm (SA), p value of (0.045)). Similarly, all operative and postoperative criteria were comparable among the study groups. Noticeably, (RVEDD) size remodeled better postoperatively in (DB) group as compared to the other two groups, (2.54 ± 0.26 cm compared to 2.83 ± 0.311 cm (DV) and to 2.72 ± 0.29 cm (SA), mean difference values were group (0.64 ± 0.47 cm) for (DB) compared to (0.18 ± 0.29 cm) for (DV) or to (0.16 ± 0.45 cm) for (SA) with p value of 0.000. The majority of patients in each group did not have tricuspid regurgitation (TR) or mild degree (+1) of (TR) on discharge. After one year of follow-up, most of the patient had either no regurgitation or grade (+1 TR). Two patients (10%) in DV group and one patient (5%) in SA group had (+3 TR). There was no statistical significance in the incidence of hospital mortality, only one patient died in DB and one in DV group (5%) and no death happened after hospital mortality for the three groups after one year.ConclusionsThe three techniques are options to repair the tricuspid valve, however, placement of Dacron band in patients undergoing tricuspid valve repair is associated with better RV remodelling, and hence, a probable better right ventricular performance and better outcome of repair is expected. A higher number of patients are needed with longer follow up period to appreciate the effect on survival and rate of freedom from tricuspid regurgitation and re-intervention.

Comparison of Dacron Band versus Segmental Annuloplastyin Treatment of Tricuspid Valve Repair

“…The mean age of the cases in Group-A was 47.97 ± 8.29 and in Group-B was 51.01 ± 7.78 with insignificant p-value.In our study the mean height was 1.66 ± 7.27, weight 73.24 ± 1.12, and BMI 26. 13 In our study post-operative RVEDD size was higher in SA group with significant p-value 0.044. In our study the p-value of post-operative grade of TR was insignificant 0.54.…”

“…Similarly Abdelgawad (2017) enrolled 11(55%) male and 9(45%) females in Dacron band group while 7(35%) females and 13 (65%) males in segmental annuloplasty group. 13 In our study the mean height was 1.66 ± 7.27, weight 73.24 ± 1.12, and BMI 26.13 ± 3.26, in Group-A while mean height, weight and BMI in Group-B was 1.69 ± 8.95, 73.20 ± 1.22, and 25.16 ± 3.39 respectively. In our data there were 52 (35.14%) hypertensive and 22(14.86%) non-hypertensive patients were in Group-A while 44 (29.73%) hypertensive and 30 (20.27%) nonhypertensive patients were in Group-B.…”

“…In our study the mean age of the cases in Group-A (Dacron Band) was 47.97 ± 8.29 and in Group-B (Segmental annuloplasty) was 51.01 ± 7.78 with insignificant p-value. In a study by Abdelgawad (2017) the mean age of the cases in Dacron Band was 38.90 ± 11.84 while in segmental annuloplasty group was 34.75 ± 11.26.…”

The best approach for functional tricuspid regurgitation: A network meta‐analysis

“…After exclusion of duplicate or irrelevant references, 114 potentially relevant articles were retrieved. After application of the inclusion and exclusion criteria, 31 relevant articles were included in the study 5,12,21‐49 : randomized trials ( n = 3), 24,42,45 propensity score‐adjusted ( n = 4), 12,26,31,46 and observational non‐adjusted ( n = 24) 5,20‐22,24,26‐29,31‐43,45‐48 …”

“…After application of the inclusion and exclusion criteria, 31 relevant articles were included in the study 5,12, : randomized trials (n = 3), 24,42,45 propensity score-adjusted (n = 4), 12,26,31,46 and observational non-adjusted (n = 24). 5,[20][21][22]24,[26][27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][48] A total of 9663 patients were included for analysis. Among them, the funnel plots did not show significant asymmetry to suggest publication bias with outcomes selected (Figure S2).…”