Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes

The purpose of this study was to compare the long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. 702 patients underwent TV repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (rin...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2006-07, Vol.114 (1), p.I577-I581
Main Authors: TANG, Gilbert H. L, DAVID, Tirone E, SINGH, Steve K, MAGANTI, Manjula D, ARMSTRONG, Susan, BORGER, Michael A
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Aortic Valve - surgery
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Coronary Artery Bypass
Coronary Disease - complications
Coronary Disease - surgery
Disease-Free Survival
Diseases of the aorta
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Female
Follow-Up Studies
Heart Diseases - mortality
Heart Valve Diseases - complications
Heart Valve Diseases - mortality
Heart Valve Diseases - surgery
Humans
Intraoperative Period
Life Tables
Male
Medical sciences
Middle Aged
Mitral Valve - surgery
Prostheses and Implants
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Sex Factors
Survival Analysis
Suture Techniques
Treatment Outcome
Tricuspid Valve - diagnostic imaging
Tricuspid Valve - surgery
Tricuspid Valve Insufficiency - epidemiology
Tricuspid Valve Insufficiency - surgery
Ultrasonography
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Summary:The purpose of this study was to compare the long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. 702 patients underwent TV repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral valve surgery in 80% of patients, aortic valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow-up was 99% complete and was 5.9+/-4.9 (mean+/-SD) years long. Ring patients were younger (55+/-14 versus 59+/-14 years; P=0.001) and less likely to have coronary artery disease (10% versus 17%; P=0.02), more likely to be female (75% versus 65%; P=0.01) and having had previous cardiac surgery (56% versus 42%; P=0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P=0.03) and event-free survival (HR, 0.8; CI, 0.6 to 1.0; P=0.04). Placement of an annuloplasty ring in patients undergoing tricuspid valve repair is associated with improved survival and event-free survival.
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.105.001263