Functional tricuspid valve (TV) regurgitation frequently affects adult with congenital heart disease (ACHD).The aim of our study was to analyze which surgical repair (suture plasty vs. ring plasty) offers the best post-operative and medium-term TV competence in ACHD.
Retrospective study of ACHD patients that underwent TV repair at our institution (01/2000-12/2016). Patient's chart were reviewed to collect pre, post-operative and follow-up data. We compared efficacy of ring plasty with suture plasty in terms of early and medium-term regurgitation degree.
95 patients had functional TV regurgitation and underwent surgery. Median age was 41.2 years (IQR:29.8-55.6 years). Pre-operative TV regurgitation: mild (n = 6), moderate (n = 42), severe (n = 47). Surgical procedure were suture plasty (n = 53), ring anuloplasty (n = 34) and in 8 it was replaced. Median hospital stay was 12 days (IQR:8-18), 2 hospital deaths (2.1%). At discharge 13.2% of the suture plasty and 11.8% of the ring anuloplasty had moderate TV regurgitation, no one had severe. After a median follow-up of 4.6 years (IQR:1.4-8.9) there were 6 late deaths giving 89% survival (95%CI:79%-94%) at 5-10 years. No tricuspid valve reoperation were performed. On follow-up echocardiographic was available in 69 patients. Suture repair present a significantly higher incidence of moderate-severe regurgitation (Figure 1) compared to the ring anuloplasty (55%vs.27.6%,p = 0.023).
Suture plasty and ring anuloplasty have comparable early postoperative results in terms of restoring valve competence. The use of prosthetic rings should be preferred to support the TV because it provides a significantly lower occurrence relevant regurgitation in the medium term.
1Cardiochirurgia delle Cardiopatie Congenite, IRCCS Policlinico San Donato San Donato Milanese
2Cardiologia Pediatrica e del Congenito Adulto, IRCCS Policlinico San Donato San Donato Milanese