To identify the determinants of both early and late tricuspid annuloplasty (TAP) failure.
From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (TR) at a single institution were included in the study. Inclusion criteria: MV disease requiring surgical intervention; no pathologic changes in TV leaflets; no previous TV repair; not requiring associated tricuspid valvuloplasty. In 423 patients, echocardiographic evaluation was performed both at discharge and after a median of 35 (22–58) months. Residual and Recurrence TR were defined as TR higher than mild. Logistic regression and Cox analysis were used as multivariable model for early and late failure. ROC curve was used to identify cutoffs
Residual TR after TAP was recorded in 54 (13%); Risk factors for residual TR were: preoperative severe TR regardless of tricuspid valve (TV) apparatus remodeling, mild or moderate TR in presence of TV apparatus remodeling, defined as coaptation depth ≥6.5 mm (sensitivity 55%; specificity 80%), tenting area ≥0.85 cm2 (52%; 75%), and tricuspid annulus ≥40 mm (60%; 72%). Recurrent TR was recorded in 85 (20%) cases, Five-year freedom from TR recurrence was 74.0 ± 3.0%. The following risk factors for recurrent TR were identified: residual TR (Figure), atrial fibrillation at follow-up, mild/ moderate TR with TV apparatus remodeling, severe TR.
Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend. Decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity.
1Department of Heart Disease, SS Hospital, Chieti, Italy Chieti
2Department of Cardiovascular Disease, University of L’Aquila, L’Aquila, Italy L’Aquila
3Prince Sultan Cardiac Center Riyadh
4Weill Cornell Medicine, Cardiac Surgery New York