Impact of the Type of Tricuspid Annuloplasty Ring Concomitant with Mitral Annuloplasty on the Right Ventricular Function: Fact or Fancy?

Background: Tricuspid valve repair has been advocated in patients undergoing mitral valve surgery who have mild or more secondary tricuspid regurgitation, current guidelines recommend tricuspid annuloplasty for not only preoperative severe TR but also for tricuspid annular dilatation (TAD) of >40 mm. we thought to analyze the impact of the type of annuloplasty ring on the right ventricular function on long term, as it has not been evaluated yet.

Methods: We performed a retrospective review of 236 patients underwent combined tricuspid and mitral valve annuloplasty in our institution between the years 2007 and 2014.

Patients were 68,8 ± 10,7 years old, 67% male, 33% female.

Patients who underwent other types of tricuspid or mitral valve surgery, other cardiac procedures, emergency interventions, history of cardiac arrhythmia, use of devices for rhythm control, resynchronization therapy, implantable cardioverter defibrillator (ICD) or both were excluded from the present study.

A total of 109 patients met the inclusion criteria; 75 received three-dimensional (3D) rigid ring (group 1) and 34 received ring annuloplasty with flexible bands (group 2). The distribution of the preoperative and perioperative variables was similar.

Patients were assessed by echocardiography before discharge, after three months and within 5 years for the degree of tricuspid regurgitation and tricuspid annular plane systolic excursion (TAPSE).

Results: There was no statistical difference in freedom from all-cause death (p = 0.29 and 0.91), cardiac and cerebrovascular deaths (p = 0.63 and 0.87) . Likewise, there was no statistically significant difference in the degree of tricuspid regurgitation, between the two groups before discharge and after 3 months.

On the other hand, after 5 years of follow up, the incidence of 2+ tricuspid regurgitation was lower in group 1 in comparison to group 2 (8,2% vs. 57,1 respectively p = 0.001), moreover group 1 showed a statistically significant improvement in TAPSE after 5 years compared with preoperative TAPSE (p = 0.001).

Conclusion: Both ring annuloplasty techniques were effective in the early postoperative period, the rigid ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than the flexible band annuloplasty after 5 years of follow up.

Publication History

Article published online:
13 February 2024